Provider Demographics
NPI:1497239321
Name:O'MALLEY, DAVID (MSW, PHD, LICSW)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:MSW, PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CROYDEN RD
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-1039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39 CROYDEN RD
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1039
Practice Address - Country:US
Practice Address - Phone:508-531-2978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113656-SW-LICSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA113656-SW-LICSWOtherCOMMONWEALTH MASSACHUSETTS - BOARD OF REGISTRATION OF SOCIAL WORKERS