Provider Demographics
NPI:1821113259
Name:O'NEILL, ANNE MARIE LAURETTA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:LAURETTA
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3059
Mailing Address - Country:US
Mailing Address - Phone:914-833-3468
Mailing Address - Fax:914-833-3468
Practice Address - Street 1:1890 PALMER AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3059
Practice Address - Country:US
Practice Address - Phone:914-833-3468
Practice Address - Fax:914-833-3468
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR00426911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN96011Medicare ID - Type Unspecified