Provider Demographics
NPI:1891951679
Name:O'NEILL, TARA KATHLEEN (MA)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:KATHLEEN
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 ROBERT TRENT JONES DR
Mailing Address - Street 2:APT #203
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2367
Mailing Address - Country:US
Mailing Address - Phone:973-223-3164
Mailing Address - Fax:
Practice Address - Street 1:3314 ROBERT TRENT JONES DR
Practice Address - Street 2:APT #203
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2367
Practice Address - Country:US
Practice Address - Phone:973-223-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 6937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health