Provider Demographics
NPI:1215138391
Name:ONEAL, DALE W (PHD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:W
Last Name:ONEAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1519
Mailing Address - Country:US
Mailing Address - Phone:949-497-6734
Mailing Address - Fax:
Practice Address - Street 1:266 GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-1519
Practice Address - Country:US
Practice Address - Phone:949-497-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP10481Medicare ID - Type Unspecified