Provider Demographics
NPI:1164457651
Name:O'MAILLE, NANCY TERESA (LISW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:TERESA
Last Name:O'MAILLE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:TERESA
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:38052 EUCLID AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-6146
Mailing Address - Country:US
Mailing Address - Phone:440-953-1214
Mailing Address - Fax:440-953-1215
Practice Address - Street 1:38052 EUCLID AVE, 103
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-6161
Practice Address - Country:US
Practice Address - Phone:440-953-1214
Practice Address - Fax:440-953-1215
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00076621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOMSW30211Medicare ID - Type Unspecified