Provider Demographics
NPI:1609149285
Name:O'NEILL, THERESA CATHERINE (LAC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:CATHERINE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BOULEVARD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1742
Mailing Address - Country:US
Mailing Address - Phone:973-321-4380
Mailing Address - Fax:
Practice Address - Street 1:420 BOULEVARD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1742
Practice Address - Country:US
Practice Address - Phone:973-321-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00107900101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor