Provider Demographics
NPI:1881162899
Name:O'MALLEY, GRACE FRIEDEN (MSW)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:FRIEDEN
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5589
Mailing Address - Country:US
Mailing Address - Phone:985-707-1410
Mailing Address - Fax:985-707-1415
Practice Address - Street 1:350 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5589
Practice Address - Country:US
Practice Address - Phone:985-707-1410
Practice Address - Fax:985-707-1415
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker