Provider Demographics
NPI:1417217878
Name:O'NEILL, MARY CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:CAROL
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:CAROL
Other - Last Name:SKAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3181
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6481
Mailing Address - Country:US
Mailing Address - Phone:925-847-5453
Mailing Address - Fax:
Practice Address - Street 1:3825 HOPYARD RD
Practice Address - Street 2:SUITE 140
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8528
Practice Address - Country:US
Practice Address - Phone:925-847-5453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 283561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical