MEDICARE: MR. ROBERT D O'NEIL LICSW

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	ISW00703	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	94232	OTHER	RI	BLUECROSS

General Provider Information

NPI Number	:	1659360618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT D O'NEIL LICSW

Provider Business Mailing Address
First Line	:	2845 POST RD
Second Line	:	SUITE 218
City	:	WARWICK
State	:	RI
Zip	:	02886-3173
Country	:	US
Telephone Number	:	401-738-7382
Fax Number	:	401-738-7385

Provider Business Practice Location Address
First Line	:	2845 POST RD
Second Line	:	SUITE 218
City	:	WARWICK
State	:	RI
Zip	:	02886-3173
Country	:	US
Telephone Number	:	401-738-7382
Fax Number	:	401-738-7385

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	08/13/2010

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