Provider Demographics
NPI:1457167769
Name:O'NEIL, JOHN CALVIN JR (LCSW, LADC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CALVIN
Last Name:O'NEIL
Suffix:JR
Gender:M
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 CHERRY ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3413
Mailing Address - Country:US
Mailing Address - Phone:203-249-7837
Mailing Address - Fax:
Practice Address - Street 1:86 CHERRY ST FL 2
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3413
Practice Address - Country:US
Practice Address - Phone:203-249-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001419101YA0400X
CT0129161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)