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General NPI Number Information
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NPI Number | 1235940503
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Entity Type | Individual
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Provider Name | RANDALL O'NEILL MA, MAT, MSW, LSW
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Gender | Male
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 2835 N SHEFFIELD AVE FL 5
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City | CHICAGO
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State | IL
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Zip | 60657-5081
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Country | US
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Telephone | 773-888-2705
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Fax |
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Provider Business Mailing Address
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Address Line | 6422 N CLAREMONT AVE APT 2S
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City | CHICAGO
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State | IL
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Zip | 60645-5455
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Country | US
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Telephone | 347-645-8310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 150.113857
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License Number State | IL
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