Provider Demographics
NPI:1780829564
Name:O'NEILL, SUSAN KAYE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAYE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:KAYE
Other - Last Name:SCHAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:376 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3466
Mailing Address - Country:US
Mailing Address - Phone:231-724-1111
Mailing Address - Fax:231-724-1300
Practice Address - Street 1:173 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3463
Practice Address - Country:US
Practice Address - Phone:231-724-6050
Practice Address - Fax:231-724-6066
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010187081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISO018708OtherBLUE CROSS BLUE SHIELD