Basic Information
| Provider Information | |||||||||
| NPI: | 1477592483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'NEILL | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | LICSW, JD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 69 HIGHLAND RD | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024457052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176674873 | ||||||||
| FaxNumber: | 6176679620 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 BROOKLINE AVE | ||||||||
| Address2: | BETH ISRAEL DEACONESS MEDICAL CENTER, HCA-SHAPIRO-6 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176674873 | ||||||||
| FaxNumber: | 6176679620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 105658 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.