1285961235 NPI number — PROF. BETH A O'MALLEY MSW, LCSW, ACSW

Table of content: PROF. BETH A O'MALLEY MSW, LCSW, ACSW (NPI 1285961235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285961235 NPI number — PROF. BETH A O'MALLEY MSW, LCSW, ACSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'MALLEY
Provider First Name:
BETH
Provider Middle Name:
A
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, ACSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLANGIARDO
Provider Other First Name:
BETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285961235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 ARCADIA RD
Provider Second Line Business Mailing Address:
SUITE 17
Provider Business Mailing Address City Name:
OLD GREENWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06870-1742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-442-5279
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 ARCADIA RD
Provider Second Line Business Practice Location Address:
SUITE 17
Provider Business Practice Location Address City Name:
OLD GREENWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06870-1742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-442-5279
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  007172 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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