Individual provider Active NPI

Erin Elizabeth O'Connor, PHD

  • Clinical Psychologist
  • Riverside, RI
National Provider Identifier
1871113001
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS01821 Issued in RI
Practice address
1011 Veterans Memorial Pkwy
Riverside, RI 02915-5061
Phone
(401) 432-1139
Fax
(401) 432-1688
NPI assigned
Apr 17, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS01821 RI Primary

Addresses

Primary practice location

1011 Veterans Memorial Pkwy
Riverside, RI 02915-5061

Mailing address

1011 Veterans Memorial Pkwy
Riverside, RI 02915-5061
Phone (401) 432-1139

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200622001772 RI Practitioner - Clinical Psychologist 9830511872 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PS01821RIMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Jul 27, 2020 Accepting new patients
Emma Pendleton Bradley Hospital CurrentSince Jul 27, 2020 Accepting new patients
Emma Pendleton Bradley Hospital CurrentSince Jul 27, 2020 Accepting new patients
Lifespan Physician Group, Inc. Clinical CurrentSince Jul 27, 2020 Accepting new patients

Locations

1 Hoppin St
Ste 204
Providence, RI 02903
Phone (401) 444-8945

593 Eddy St
Providence, RI 02903

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

1011 Veterans Memorial Pkwy
Riverside, RI 02915
Phone (401) 432-1000

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1871113001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 VETERANS MEMORIAL PKWY",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029155061",
            "telephone_number": "401-432-1139",
            "fax_number": "401-432-1688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 VETERANS MEMORIAL PKWY",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029155061",
            "telephone_number": "401-432-1139",
            "fax_number": "401-432-1688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "ERIN",
        "middle_name": "ELIZABETH",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-17",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "RI",
            "license": "PS01821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, RI

Sources for this page

Verify at the official NPI Registry.