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General NPI Number Information
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NPI Number | 1952735698
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Entity Type | Individual
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Provider Name | SEAN T. O'NEIL LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 3180 PEGER RD SUITE 250
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City | FAIRBANKS
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State | AK
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Zip | 99709-5453
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Country | US
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Telephone | 907-590-9204
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 84765
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City | FAIRBANKS
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State | AK
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Zip | 99708-4765
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Country | US
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Telephone |
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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 | 1258
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License Number State | AK
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