Provider Demographics
NPI:1467691527
Name:O'MARA, TERESA EILEEN (LCSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:EILEEN
Last Name:O'MARA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SANGYE
Other - Middle Name:
Other - Last Name:O'MARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1109 SOUTHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5352
Mailing Address - Country:US
Mailing Address - Phone:512-699-2533
Mailing Address - Fax:
Practice Address - Street 1:1109 SOUTHWOOD RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5352
Practice Address - Country:US
Practice Address - Phone:512-699-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical