Provider Demographics
NPI:1851493316
Name:O'NEILL, MARY KERIN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KERIN
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 1:215 HALLOCK RD STE 6C
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3081
Mailing Address - Country:US
Mailing Address - Phone:631-751-4720
Mailing Address - Fax:
Practice Address - Street 1:215 HALLOCK RD STE 6C
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3081
Practice Address - Country:US
Practice Address - Phone:631-751-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026832-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7A391Medicare ID - Type Unspecified