Provider Demographics
NPI:1538685144
Name:O'NEAL, VENESSA C (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:VENESSA
Middle Name:C
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PELHAM PKWY S RM 1E4
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1119
Mailing Address - Country:US
Mailing Address - Phone:718-918-6177
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY, S,
Practice Address - Street 2:ROOM 1E4
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-918-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089020-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246048Medicaid
NY002460048Medicaid