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Provider Information for 1689078552


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CAROLYN O'NEAL LCSW


Sex: Female

NPI: 1689078552
Last Updated: 2020-01-30
Certification Date: 2020-01-30

Details

NameValue
NPI1689078552
Enumeration Date2014-10-21
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 1065 SOUTHERN BLVD
BRONX, NY 10459-2417
United States

Phone: 718-589-2440 | Fax:718-991-4516
 
Primary Practice Address 3209 3RD AVE
BRONX, NY 10451-4203
United States

Phone: 718-589-2440 | Fax:
 
Secondary Practice Address(es)

1065 SOUTHERN BLVD
BRONX, NY 10459-2417
United States

Phone: 718-589-2440 | Fax:718-991-4516
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)NY093169-1License
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalNY089075
No 104100000X - Social Worker NY093169-1