Healthcare Provider Details

I. General information

NPI: 1942350467
Provider Name (Legal Business Name): LISE G. O'NEILL MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANCHESTER MEMORIAL HOSPITAL 71 HAYNES ST
MANCHESTER CT
06042
US

IV. Provider business mailing address

20 NORTHFIELD ST
MANCHESTER CT
06042-2335
US

V. Phone/Fax

Practice location:
  • Phone: 860-533-3434
  • Fax: 860-647-6829
Mailing address:
  • Phone: 860-646-9794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000529
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: