MEDICARE: MRS. CHRISTINA M ONEIL LCSWR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	R052073	NY

General Provider Information

NPI Number	:	1073632485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA M ONEIL LCSWR

Provider Business Mailing Address
First Line	:	218 STONE ST FL 2
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-3211
Country	:	US
Telephone Number	:	315-782-7445
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 STONE ST FL 2
Second Line	:
City	:	WATERTOWN
State	:	NY
Zip	:	13601-3211
Country	:	US
Telephone Number	:	315-782-7445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/07/2011

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