Provider Demographics
NPI:1689001679
Name:OHEANEY, WILLIAM C (LADC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:OHEANEY
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 BRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3532
Mailing Address - Country:US
Mailing Address - Phone:860-629-0428
Mailing Address - Fax:860-210-0813
Practice Address - Street 1:62 BRIDGE STREET
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3532
Practice Address - Country:US
Practice Address - Phone:860-629-0428
Practice Address - Fax:860-210-0813
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001055101YA0400X
CT002828101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008048997Medicaid