Provider Demographics
NPI:1013523836
Name:OMALLEY, CHRISTINE J (LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:OMALLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LEE HILL RD APT 6
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1737
Mailing Address - Country:US
Mailing Address - Phone:617-512-7819
Mailing Address - Fax:
Practice Address - Street 1:2 LEE HILL RD APT 6
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1737
Practice Address - Country:US
Practice Address - Phone:617-512-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical