MEDICARE: LISETTE O'NEAL LCSW

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
2	1041C0700X	Clinical Social Worker
3	1041C0700X	Clinical Social Worker	29743	CA

General Provider Information

NPI Number	:	1699909382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISETTE O'NEAL LCSW

Provider Business Mailing Address
First Line	:	2322 PINE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-3028
Country	:	US
Telephone Number	:	714-454-9124
Fax Number	:

Provider Business Practice Location Address
First Line	:	2322 PINE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-3028
Country	:	US
Telephone Number	:	714-454-9124
Fax Number	:

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

Provider Enumeration Date	:	05/08/2009
Last Update Date	:	06/20/2014

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