Provider Demographics
NPI:1629184494
Name:O'NEILL, CAREY A (PSYD)
Entity Type:Individual
Prefix:
First Name:CAREY
Middle Name:A
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PINE BROOK CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3746
Mailing Address - Country:US
Mailing Address - Phone:203-699-9770
Mailing Address - Fax:203-699-9780
Practice Address - Street 1:4 PINE BROOK CT
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3746
Practice Address - Country:US
Practice Address - Phone:203-699-9770
Practice Address - Fax:203-699-9770
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002711103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical