Provider Demographics
NPI:1932725306
Name:O'MALLEY, MADELINE CATHERINE (LC10651)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:CATHERINE
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:LC10651
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 UPSHUR LN
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1437
Mailing Address - Country:US
Mailing Address - Phone:443-605-2153
Mailing Address - Fax:
Practice Address - Street 1:10031 OLD OCEAN CITY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1174
Practice Address - Country:US
Practice Address - Phone:443-605-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP88301041C0700X
MDLC10651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical