Provider Demographics
NPI:1619381258
Name:O'NEIL, AMY JEAN
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEAN
Last Name:O'NEIL
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 1:40300 WASHINGTON ST APT R101
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9564
Mailing Address - Country:US
Mailing Address - Phone:760-567-9984
Mailing Address - Fax:
Practice Address - Street 1:40300 WASHINGTON ST APT R101
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-9564
Practice Address - Country:US
Practice Address - Phone:760-567-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor