Basic Information
| Provider Information | |||||||||
| NPI: | 1588677009 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'MALLEY | ||||||||
| FirstName: | KATHY | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314273700 | ||||||||
| FaxNumber: | 6314274268 | ||||||||
| Practice Location | |||||||||
| Address1: | 66 NEWTOWN LANE | ||||||||
| Address2: | |||||||||
| City: | EAST HAMPTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313243344 | ||||||||
| FaxNumber: | 6313246709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 069982 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.