MEDICARE: SHERIDAN ONEAL LICENSED CLINICAL SOCIAL WORKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1497692172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERIDAN ONEAL LICENSED CLINICAL SOCIAL WORKER

Provider Business Mailing Address
First Line	:	1274 N CRESCENT HEIGHTS BLVD APT 125
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5059
Country	:	US
Telephone Number	:	323-240-0574
Fax Number	:

Provider Business Practice Location Address
First Line	:	1274 N CRESCENT HEIGHTS BLVD APT 125
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5059
Country	:	US
Telephone Number	:	323-240-0574
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERIDAN NOLAN GODFREY O'NEAL
Credential	:	LCSW
Telephone Number	:	323-240-0574

Provider Enumeration Date	:	05/01/2026
Last Update Date	:	05/05/2026

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