Provider Demographics
NPI:1912325085
Name:KATHLEEN O'MEARA, APRN PC
Entity Type:Organization
Organization Name:KATHLEEN O'MEARA, APRN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'MEARA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, APRN
Authorized Official - Phone:781-431-0207
Mailing Address - Street 1:27 MICA LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1724
Mailing Address - Country:US
Mailing Address - Phone:781-431-0207
Mailing Address - Fax:
Practice Address - Street 1:27 MICA LN
Practice Address - Street 2:SUITE 205
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1724
Practice Address - Country:US
Practice Address - Phone:781-431-0207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53227983261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health