1609897255 NPI number — BERNADETTE M O'NEIL LICSW,LADC

Table of content: BERNADETTE M O'NEIL LICSW,LADC (NPI 1609897255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609897255 NPI number — BERNADETTE M O'NEIL LICSW,LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'NEIL
Provider First Name:
BERNADETTE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW,LADC
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1609897255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
326 NORTHVIEW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLISTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05495-7353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-879-6030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 W SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINOOSKI
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05404-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-316-6885
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2006

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: 101YA0400X , with the licence number:  000279 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 089-0000449 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 2088553 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 61838 . This is a "MVP PROVIDER NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1006693 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18989 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 19746 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 205797 . This is a "MAGELLAN PROVIDER NUMBER" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 073918 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 425562 . This is a "HARVARD PILGRAM HELATH" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com