Provider Demographics
NPI:1134646789
Name:O'MARA, CAMERON (LCSW)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:O'MARA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 WALNUT ST STE 653
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4718
Mailing Address - Country:US
Mailing Address - Phone:267-551-1047
Mailing Address - Fax:
Practice Address - Street 1:1845 WALNUT ST STE 653
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4718
Practice Address - Country:US
Practice Address - Phone:267-551-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0205981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty