MEDICARE: KELLY O'NEILL

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	CW022301	PA

General Provider Information

NPI Number	:	1881463107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY O'NEILL

Provider Business Mailing Address
First Line	:	306 ANTHEM WAY
Second Line	:
City	:	CHALFONT
State	:	PA
Zip	:	18914-1930
Country	:	US
Telephone Number	:	609-425-6298
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 CHESTNUT ST FL 5
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4117
Country	:	US
Telephone Number	:	215-665-8670
Fax Number	:

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

Provider Enumeration Date	:	12/28/2023
Last Update Date	:	12/28/2023

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