Provider Demographics
NPI:1902044043
Name:O'MALLEY, PATRICK GEORGE III
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:GEORGE
Last Name:O'MALLEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17425 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2364
Mailing Address - Country:US
Mailing Address - Phone:708-268-6406
Mailing Address - Fax:
Practice Address - Street 1:17425 84 AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2364
Practice Address - Country:US
Practice Address - Phone:708-268-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst