Provider Demographics
NPI:1417062605
Name:O'NEEL, KELLEY ANN (PHD)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:ANN
Last Name:O'NEEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4322
Mailing Address - Country:US
Mailing Address - Phone:508-747-2718
Mailing Address - Fax:508-747-5209
Practice Address - Street 1:323 COURT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4322
Practice Address - Country:US
Practice Address - Phone:508-747-2718
Practice Address - Fax:508-747-5209
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6039103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO 4853Medicare ID - Type Unspecified
MAWO4853Medicare UPIN