Provider Demographics
NPI:1659360618
Name:O'NEIL, ROBERT D (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:O'NEIL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 POST RD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-3173
Mailing Address - Country:US
Mailing Address - Phone:401-738-7382
Mailing Address - Fax:401-738-7385
Practice Address - Street 1:2845 POST RD
Practice Address - Street 2:SUITE 218
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-3173
Practice Address - Country:US
Practice Address - Phone:401-738-7382
Practice Address - Fax:401-738-7385
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW007031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI94232OtherBLUECROSS
RI809009423Medicare ID - Type Unspecified