Healthcare Provider Details

I. General information

NPI: 1457167769
Provider Name (Legal Business Name): JOHN CALVIN O'NEIL JR. LCSW, LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 CHERRY ST FL 2
MILFORD CT
06460-3413
US

IV. Provider business mailing address

86 CHERRY ST FL 2
MILFORD CT
06460-3413
US

V. Phone/Fax

Practice location:
  • Phone: 203-249-7837
  • Fax:
Mailing address:
  • Phone: 203-249-7837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number001419
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0136543TELE
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number012916
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: