Provider Demographics
NPI:1225371453
Name:ONEILL, ROBERT (MED)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:ONEILL
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SW LANCE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2173
Mailing Address - Country:US
Mailing Address - Phone:772-353-2420
Mailing Address - Fax:
Practice Address - Street 1:2001 SW LANCE AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2173
Practice Address - Country:US
Practice Address - Phone:772-353-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-06
Last Update Date:2013-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS-927103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool