MEDICARE: KASEY CHARLOTTE O'NEAL MSW, LISW, ACHT

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	1041C0700X	Clinical Social Worker	I.2203932	OH

General Provider Information

NPI Number	:	1538717442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY CHARLOTTE O'NEAL MSW, LISW, ACHT

Provider Business Mailing Address
First Line	:	12331 WATERSTONE LN APT 723
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-3046
Country	:	US
Telephone Number	:	419-707-9792
Fax Number	:

Provider Business Practice Location Address
First Line	:	2735 N HOLLAND SYLVANIA RD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1846
Country	:	US
Telephone Number	:	419-318-9840
Fax Number	:

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

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	12/14/2022

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