Provider Demographics
NPI:1770648701
Name:O'NEILL, MARY F (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:F
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 BEACON ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4808
Mailing Address - Country:US
Mailing Address - Phone:617-739-0454
Mailing Address - Fax:
Practice Address - Street 1:1419 BEACON ST
Practice Address - Street 2:SUITE 11
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4808
Practice Address - Country:US
Practice Address - Phone:617-739-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6629101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health