Provider Demographics
NPI:1609897255
Name:O'NEIL, BERNADETTE M (LICSW,LADC)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:M
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:LICSW,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 NORTHVIEW CT
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7353
Mailing Address - Country:US
Mailing Address - Phone:802-879-6030
Mailing Address - Fax:
Practice Address - Street 1:127 W SPRING ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1936
Practice Address - Country:US
Practice Address - Phone:802-316-6885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000279101YA0400X
VT089-00004491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT2088553OtherCIGNA PROVIDER NUMBER
VT61838OtherMVP PROVIDER NUMBER
VT1006693Medicaid
VT18989OtherBLUE CROSS BLUE SHIELD
VT19746OtherBLUE CROSS BLUE SHIELD
VT205797OtherMAGELLAN PROVIDER NUMBER
VT073918OtherVALUE OPTIONS
VT425562OtherHARVARD PILGRAM HELATH
VT205797OtherMAGELLAN PROVIDER NUMBER