Basic Information
| Provider Information | |||||||||
| NPI: | 1396263919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'CONNOR | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 W THOMAS RD STE 401 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024064373 | ||||||||
| FaxNumber: | 6024064406 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 W THOMAS RD STE 401 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024064373 | ||||||||
| FaxNumber: | 6024064406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2017 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 4846 | AZ | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC0700X | 4846 | AZ | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | 4846 | AZ | N | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.