Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 830 | AZ |
Y | 103TC0700X | Clinical Psychologist | 830 | AZ |
N | 102L00000X | Psychologist | 830 | AZ |
N | 103T00000X | Psychologist | 830 | AZ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 830 | AZ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 830 | AZ |
N | 103G00000X | Clinical Psychologist | 830 | AZ |
N | 103TC0700X | Clinical Psychologist | 830 | AZ |
N | 103TF0200X | Forensic Psychologist | 830 | AZ |
N | 103TH0100X | Health Service | 830 | AZ |
N | 103TR0400X | Rehabilitation Psychologist | 830 | AZ |
NPI | 1316084817 |
---|---|
Provider Name | Catherine S O'connell |
First Address | Phoenix, AZ 85012-2112 |
Second Address | Phoenix, AZ 85012-2112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 19/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R61062 | (02) | AZ |