Provider Demographics
NPI:1952432908
Name:O'NEILL, DIANE W
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:W
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:C
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2843 SOUTH COUNTY TRAIL
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1728
Mailing Address - Country:US
Mailing Address - Phone:401-743-2007
Mailing Address - Fax:866-585-6452
Practice Address - Street 1:2843 SOUTH COUNTY TRAIL
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-1728
Practice Address - Country:US
Practice Address - Phone:401-743-2007
Practice Address - Fax:866-585-6452
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW018191041C0700X
FLSW20101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical