Provider Demographics
NPI:1982740247
Name:O'MALLEY, PAMELA (LICSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1231
Mailing Address - Country:US
Mailing Address - Phone:508-829-0776
Mailing Address - Fax:
Practice Address - Street 1:100 LEDGEWOOD PL
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-1075
Practice Address - Country:US
Practice Address - Phone:781-871-6550
Practice Address - Fax:781-871-5973
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1026061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23460Medicare ID - Type Unspecified