Provider Demographics
NPI:1487841292
Name:O'MALLEY, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 MARKET ST
Mailing Address - Street 2:BOX 1934
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3133
Mailing Address - Country:US
Mailing Address - Phone:215-387-6055
Mailing Address - Fax:215-387-7989
Practice Address - Street 1:3901 MARKET ST
Practice Address - Street 2:BOX 1934
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3133
Practice Address - Country:US
Practice Address - Phone:215-387-6055
Practice Address - Fax:215-387-7989
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101995771 0001Medicaid