Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 17024 | MN |
NPI | 1003000795 |
---|---|
Provider Name | Mr. Michael Joseph O'neill |
First Address | Saint Paul, MN 55104-3453 |
Second Address | Saint Paul, MN 55104-3453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2007 |
Last Update Date | 05/09/2007 |