Provider Demographics
NPI:1447546148
Name:O'MALLEY, MAUREEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-4428
Mailing Address - Country:US
Mailing Address - Phone:207-798-1136
Mailing Address - Fax:
Practice Address - Street 1:141 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2055
Practice Address - Country:US
Practice Address - Phone:207-907-4343
Practice Address - Fax:207-907-4343
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC13076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health