Provider Demographics
NPI:1740047513
Name:O'NEAL, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W SUNNYSIDE WAY APT 324
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1498
Mailing Address - Country:US
Mailing Address - Phone:315-240-7605
Mailing Address - Fax:
Practice Address - Street 1:441 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1420
Practice Address - Country:US
Practice Address - Phone:518-453-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health