Provider Demographics
NPI:1245588995
Name:O'NEILL, JOHN (MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 W NO NAME RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-7783
Mailing Address - Country:US
Mailing Address - Phone:407-267-6880
Mailing Address - Fax:618-493-6390
Practice Address - Street 1:1052 W NO NAME RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62902-7783
Practice Address - Country:US
Practice Address - Phone:407-267-6880
Practice Address - Fax:618-493-6390
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst