Provider Demographics
NPI:1275872517
Name:O'NEIL, LOREN MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LOREN
Middle Name:MARIE
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 BROADWAY APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-6225
Mailing Address - Country:US
Mailing Address - Phone:860-608-4183
Mailing Address - Fax:
Practice Address - Street 1:54 MACDONOUGH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2304
Practice Address - Country:US
Practice Address - Phone:718-483-9290
Practice Address - Fax:718-483-9287
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03505424Medicaid