Provider Demographics
NPI:1326428517
Name:O'NEILL, MARK S (LICSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 OAK ST
Mailing Address - Street 2:APT C
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1932
Mailing Address - Country:US
Mailing Address - Phone:401-237-2203
Mailing Address - Fax:
Practice Address - Street 1:70 OAK ST
Practice Address - Street 2:APT C
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1932
Practice Address - Country:US
Practice Address - Phone:401-237-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW024021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical