Provider Demographics
NPI:1881896579
Name:O'MALLEY, JEFFREY CARL (LCSW)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:CARL
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 5TH AVE
Mailing Address - Street 2:SUITE 1408-2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8002
Mailing Address - Country:US
Mailing Address - Phone:917-865-8438
Mailing Address - Fax:
Practice Address - Street 1:300 FLATBUSH AVENUE
Practice Address - Street 2:BROOKLYN CENTER FOR PSYCHOTHERAPY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2363
Practice Address - Country:US
Practice Address - Phone:917-865-8438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077388-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical