Basic Information
| Provider Information | |||||||||
| NPI: | 1114256328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'NEIL | ||||||||
| FirstName: | EDITHA | ||||||||
| MiddleName: | ERICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2422 E 68TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462201317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174661000 | ||||||||
| FaxNumber: | 3174662000 | ||||||||
| Practice Location | |||||||||
| Address1: | 4740 KINGSWAY DR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462051521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174661000 | ||||||||
| FaxNumber: | 3174662000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2009 | ||||||||
| LastUpdateDate: | 12/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 33005531A | IN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.