Provider Demographics
NPI:1407060296
Name:OMALLEY, MEREDITH (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:OMALLEY
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18532 FIRLANDS WAY N
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3986
Mailing Address - Country:US
Mailing Address - Phone:206-240-3945
Mailing Address - Fax:
Practice Address - Street 1:18532 FIRLANDS WAY N
Practice Address - Street 2:SUITE A
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3986
Practice Address - Country:US
Practice Address - Phone:206-240-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00007322104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker