Provider Demographics
NPI:1417227588
Name:O'NEILL, JOHANNA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BALHUINIA STREET LOIZA VALLEY SHOOPING CENTER
Mailing Address - Street 2:LOCAL AA-6
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-256-0273
Mailing Address - Fax:787-876-7856
Practice Address - Street 1:LOIZA VALLEY SHOOPING CENTER
Practice Address - Street 2:LOCAL AA-6
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-256-0273
Practice Address - Fax:787-876-7856
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR94191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical