NPIMap

Organization Active NPI

Timothy O'Connor, L.C.S.W., P.a.

  • Adult Mental Health Clinic/Center
  • Fort Lauderdale, FL
National Provider Identifier
1821436130
Registry record updated Jun 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
SW5622 Issued in FL
Legal business name
TIMOTHY O'CONNOR, L.C.S.W., P.A.
Practice address
1919 NE 45TH St Ste 122
Fort Lauderdale, FL 33308-5135
Phone
(954) 776-7176
Fax
(954) 776-7160
NPI assigned
Jun 8, 2013
Last updated
Jun 8, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Timothy Joseph O'Connor, L.C.S.W.NPI 1124155726
Title
President
Phone
(954) 776-7176

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X SW5622 FL Primary

Addresses

Primary practice location

1919 NE 45TH St Ste 122
Fort Lauderdale, FL 33308-5135

Mailing address

1919 NE 45TH St Ste 122
Fort Lauderdale, FL 33308-5135
Phone (954) 776-7176

Other identifiers 1

IdentifierTypeStateIssuer
7638663MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130723000855 FL Part B Supplier - Clinic/Group Practice 8527209261 Receives reassigned benefits from 1 practitioner
Practice locations: Fort Lauderdale, FL

National Provider Directory

National Provider Directory

Locations

1925 NE 45th St
Ste 129
Fort Lauderdale, FL 33308
Phone (954) 801-7407

1919 NE 45th St
Ste 120
Ft Lauderdale, FL 33308
Phone (954) 801-7407

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370649600000",
    "number": "1821436130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 NE 45TH ST STE 122",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333085135",
            "telephone_number": "954-776-7176",
            "fax_number": "954-776-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 NE 45TH ST STE 122",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333085135",
            "telephone_number": "954-776-7176",
            "fax_number": "954-776-7160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY O'CONNOR, L.C.S.W., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-08",
        "last_updated": "2013-06-08",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-776-7176",
        "authorized_official_credential": "L.C.S.W."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "FL",
            "license": "SW5622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7638663",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.