Provider Demographics
NPI:1659608727
Name:O'MEARA, JOAN VERONICA (RN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:VERONICA
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:V
Other - Last Name:O'MEARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:37 COSBY AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2003
Mailing Address - Country:US
Mailing Address - Phone:413-582-2511
Mailing Address - Fax:413-582-2838
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:413-582-2511
Practice Address - Fax:413-582-2838
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10223251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP20809Medicare UPIN