Provider Demographics
NPI:1851330864
Name:O'NEILL, STEPHEN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MAPLE RD
Mailing Address - Street 2:STE 340
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6308
Mailing Address - Country:US
Mailing Address - Phone:248-910-4636
Mailing Address - Fax:
Practice Address - Street 1:300 E MAPLE RD
Practice Address - Street 2:STE 340
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6308
Practice Address - Country:US
Practice Address - Phone:248-910-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI069553103T00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP12140039Medicare ID - Type UnspecifiedINDIVIDUAL ID NUMBER