Healthcare Provider Details

I. General information

NPI: 1225431349
Provider Name (Legal Business Name): MICHAEL JEROME O'NEILL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD UNIT B
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

375 LAGUNA HONDA BLVD
SAN FRANCISCO CA
94116-1411
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-6829
  • Fax: 415-473-4113
Mailing address:
  • Phone: 628-217-7341
  • Fax: 415-759-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130166
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW130166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: