Provider Demographics
NPI:1811208473
Name:O'NEIL, LISA ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:CT
Mailing Address - Zip Code:06756-1510
Mailing Address - Country:US
Mailing Address - Phone:860-307-5361
Mailing Address - Fax:860-491-9136
Practice Address - Street 1:9 NORTH ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:CT
Practice Address - Zip Code:06756-1510
Practice Address - Country:US
Practice Address - Phone:860-307-5361
Practice Address - Fax:860-491-9136
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001478106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist