Provider Demographics
NPI:1487017034
Name:O'NEIL, KENDRA-LEIGH
Entity Type:Individual
Prefix:
First Name:KENDRA-LEIGH
Middle Name:
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 113
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-0113
Mailing Address - Country:US
Mailing Address - Phone:617-773-0633
Mailing Address - Fax:617-773-2233
Practice Address - Street 1:11 RIVERBANK RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-3326
Practice Address - Country:US
Practice Address - Phone:617-773-0633
Practice Address - Fax:617-773-2233
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1158071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical