Provider Demographics
NPI:1033263595
Name:ONEILL, JOHN P (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:ONEILL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 BLACK BROOK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1070
Mailing Address - Country:US
Mailing Address - Phone:508-238-7485
Mailing Address - Fax:
Practice Address - Street 1:137 BLACK BROOK RD
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1070
Practice Address - Country:US
Practice Address - Phone:508-238-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA106166OtherSTATE LICENSURE