Provider Demographics
NPI:1568703809
Name:O'NEILL-KEARTON, TERRY MARIE
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:MARIE
Last Name:O'NEILL-KEARTON
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 1:101 E GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2743
Mailing Address - Country:US
Mailing Address - Phone:508-947-3634
Mailing Address - Fax:508-947-4306
Practice Address - Street 1:543 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5623
Practice Address - Country:US
Practice Address - Phone:508-399-7709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA406574101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor