Provider Demographics
NPI:1588653950
Name:O'NEILL, MARK LEWIS (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:LEWIS
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ELRAY RD.
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087
Mailing Address - Country:US
Mailing Address - Phone:410-592-7517
Mailing Address - Fax:
Practice Address - Street 1:19 ELRAY RD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21087-1741
Practice Address - Country:US
Practice Address - Phone:410-592-7517
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD002181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical