Provider Demographics
NPI:1407992043
Name:O'MALLEY, DANIEL EDWARD (MA CAGS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:EDWARD
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:MA CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109
Mailing Address - Country:US
Mailing Address - Phone:413-598-0338
Mailing Address - Fax:
Practice Address - Street 1:503 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4101
Practice Address - Country:US
Practice Address - Phone:413-598-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health