Healthcare Provider Details

I. General information

NPI: 1881238376
Provider Name (Legal Business Name): ABIGAIL MCNEIL MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N ROOSEVELT DR., SUITE 104
SEASIDE OR
97138
US

IV. Provider business mailing address

1150 N ROOSEVELT DR., SUITE 104
SEASIDE OR
97138
US

V. Phone/Fax

Practice location:
  • Phone: 503-717-7154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL8231
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierL8231
Identifier TypeOTHER
Identifier State
Identifier IssuerLICENSED CLINICAL SOCIAL WORKER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: