Individual provider Active NPI

Teresa L O'Connor, LCSW-R

  • Social Worker
  • Wellsville, NY
National Provider Identifier
1871780882
Registry record updated May 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
084628-1 Issued in NY
Practice address
75 Pine St
Wellsville, NY 14895-1421
Phone
(585) 593-2261
Fax
(585) 593-2261
NPI assigned
Oct 3, 2007
Last updated
May 3, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Social Worker 104100000X 084628-1 NY Primary

Addresses

Primary practice location

75 Pine St
Wellsville, NY 14895-1421

Mailing address

75 Pine St
Wellsville, NY 14895-1421
Phone (585) 593-2261

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20220408000678 NY Practitioner - Clinical Social Worker 8426440413 Practice locations: Wellsville, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
State University of New York at Buffalo School of Medicine, 2011
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

75 Pine St
Wellsville, NY 14895-1421
Phone (585) 808-1558

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
084628-1NYMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1191369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1871780882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 PINE ST",
            "city": "WELLSVILLE",
            "state": "NY",
            "postal_code": "148951421",
            "telephone_number": "585-593-2261",
            "fax_number": "585-593-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 PINE ST",
            "city": "WELLSVILLE",
            "state": "NY",
            "postal_code": "148951421",
            "telephone_number": "585-593-2261",
            "fax_number": "585-593-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "TERESA",
        "middle_name": "L",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-03",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "084628-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellsville, NY

Sources for this page

Verify at the official NPI Registry.