Provider Demographics
NPI:1508295676
Name:O'NEILL, THEODORA ANN (37AC00117100)
Entity Type:Individual
Prefix:MRS
First Name:THEODORA
Middle Name:ANN
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:37AC00117100
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 NEW MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2231
Mailing Address - Country:US
Mailing Address - Phone:732-284-3720
Mailing Address - Fax:
Practice Address - Street 1:168 NEW MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2231
Practice Address - Country:US
Practice Address - Phone:732-284-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00117100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor