Provider Demographics
NPI:1942488994
Name:O'NEILL, PAMELA A (MA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
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 1:273 GROGAN RD
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01005-9242
Mailing Address - Country:US
Mailing Address - Phone:978-424-6058
Mailing Address - Fax:
Practice Address - Street 1:273 GROGAN ROAD
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:MA
Practice Address - Zip Code:01005-0434
Practice Address - Country:US
Practice Address - Phone:978-424-6058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist