MEDICARE: DR. MOLLY E O'NEIL PSYD

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	103T00000X	Psychologist	PSYC.PY.60691446	WA
2	174400000X	Specialist	MA00015198	WA
3	103TC0700X	Clinical Psychologist	PY60691446	WA

General Provider Information

NPI Number	:	1568512416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLLY E O'NEIL PSYD

Provider Business Mailing Address
First Line	:	2118 CATON WAY SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-1105
Country	:	US
Telephone Number	:	360-951-4009
Fax Number	:	360-352-3289

Provider Business Practice Location Address
First Line	:	2118 CATON WAY SW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-1105
Country	:	US
Telephone Number	:	360-951-4009
Fax Number	:	360-352-3289

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	02/05/2020

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