Provider Demographics
NPI:1114135837
Name:O'MARA, STACY MOORE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:MOORE
Last Name:O'MARA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 SEMINOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3057
Mailing Address - Country:US
Mailing Address - Phone:407-405-0585
Mailing Address - Fax:
Practice Address - Street 1:661 SEMINOLA BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3057
Practice Address - Country:US
Practice Address - Phone:407-405-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9094101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor