Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3742 | MA |
N | 103T00000X | Psychologist | 3742 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3742 | MA |
N | 103G00000X | Clinical Psychologist | 3742 | MA |
N | 103TC0700X | Clinical Psychologist | 3742 | MA |
NPI | 1184603334 |
---|---|
Provider Name | Dr. Peter Richard Oconnor |
First Address | Belmont, MA 02478-4448 |
Second Address | Belmont, MA 02478-4448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0515751 | (05) | MA |
R44356 | (02) | MA |