Provider Demographics
NPI:1275627499
Name:ONEIL, MARIBETH (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIBETH
Middle Name:
Last Name:ONEIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 N MARINE DR
Mailing Address - Street 2:APT 804
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1724
Mailing Address - Country:US
Mailing Address - Phone:773-230-7811
Mailing Address - Fax:
Practice Address - Street 1:4452 N GREENVIEW AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5904
Practice Address - Country:US
Practice Address - Phone:847-570-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490065171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL320021833OtherFEDERAL TAX I.D. NUMBER
IL320021833OtherFEDERAL TAX I.D. NUMBER