Provider Demographics
NPI:1114196698
Name:O'REARDON, CARMEL MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:CARMEL
Middle Name:MARY
Last Name:O'REARDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CORE
Other - Middle Name:COMMUNITY
Other - Last Name:CARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2828 BAMMEL LN APT 810
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1146
Mailing Address - Country:US
Mailing Address - Phone:832-721-7470
Mailing Address - Fax:
Practice Address - Street 1:2828 BAMMEL LN APT 810
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1146
Practice Address - Country:US
Practice Address - Phone:832-721-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX341401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01411352OtherAMERIGROUP
TX172970907Medicaid
TX172970902Medicaid
TX172970903Medicaid
TXTXB122976OtherMEDICARE