Provider Demographics
NPI:1649498742
Name:O'MALLEY, MARY B (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:B
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434B STOCKBRIDGE RD LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1295
Mailing Address - Country:US
Mailing Address - Phone:203-556-4846
Mailing Address - Fax:
Practice Address - Street 1:SMMC, DEPT OF PSYCHIATRY
Practice Address - Street 2:25 JUNE ST
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073
Practice Address - Country:US
Practice Address - Phone:207-324-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2421782084S0012X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine