Provider Demographics
NPI:1235936725
Name:O'CONNELL, MICHAEL R (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3322
Mailing Address - Country:US
Mailing Address - Phone:315-489-8206
Mailing Address - Fax:
Practice Address - Street 1:4355 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1621
Practice Address - Country:US
Practice Address - Phone:312-600-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490264461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical