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
Certification Date: 2020-01-30
Details
Name | Value | ||||||||||||
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NPI | 1689078552 | ||||||||||||
Enumeration Date | 2014-10-21 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | NO | ||||||||||||
Status | Active | ||||||||||||
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 | ||||||||||||
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