1215245733 NPI number — LAURA MARGARET MORRELL O'NEILL MSW, LCSW

Table of content: LAURA MARGARET MORRELL O'NEILL MSW, LCSW (NPI 1215245733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215245733 NPI number — LAURA MARGARET MORRELL O'NEILL MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'NEILL
Provider First Name:
LAURA
Provider Middle Name:
MARGARET MORRELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORRELL
Provider Other First Name:
LAURA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215245733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
153 MAGAZINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01109-4016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-218-6976
Provider Business Mailing Address Fax Number:
413-382-7119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-646-3888
Provider Business Practice Location Address Fax Number:
860-645-4132
Provider Enumeration Date:
09/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 010018 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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