Provider Demographics
NPI:1235940503
Name:O'NEILL, RANDALL (MA, MAT, MSW, LSW)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:MA, MAT, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6422 N CLAREMONT AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-5455
Mailing Address - Country:US
Mailing Address - Phone:347-645-8310
Mailing Address - Fax:
Practice Address - Street 1:2835 N SHEFFIELD AVE FL 5
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5081
Practice Address - Country:US
Practice Address - Phone:773-888-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1138571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical