Provider Demographics
NPI:1073610523
Name:ONEAL, MARTHA K (MSW LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:K
Last Name:ONEAL
Suffix:
Gender:F
Credentials:MSW LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11741 S ROUNDTREE
Mailing Address - Street 2:#103
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-2743
Mailing Address - Country:US
Mailing Address - Phone:913-780-1002
Mailing Address - Fax:913-780-1006
Practice Address - Street 1:11741 S ROUNDTREE
Practice Address - Street 2:#103
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-2743
Practice Address - Country:US
Practice Address - Phone:913-780-1002
Practice Address - Fax:913-780-1006
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW0670103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS000A640Medicare ID - Type Unspecified