Provider Demographics
NPI:1194063164
Name:O'NEILL, KARI CIACIUCH (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:CIACIUCH
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22526 SE 64TH PL
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5368
Mailing Address - Country:US
Mailing Address - Phone:425-786-8566
Mailing Address - Fax:
Practice Address - Street 1:22526 SE 64TH PL
Practice Address - Street 2:SUITE 220
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5368
Practice Address - Country:US
Practice Address - Phone:425-786-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW603135021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical