Healthcare Provider Details

I. General information

NPI: 1295664266
Provider Name (Legal Business Name): MARYANNE O'MALLEY PCD (DONA), BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 COMMONWEALTH AVE APT 10B
BOSTON MA
02115-1910
US

IV. Provider business mailing address

321 COMMONWEALTH AVE APT 10B
BOSTON MA
02115-1910
US

V. Phone/Fax

Practice location:
  • Phone: 617-909-6001
  • Fax:
Mailing address:
  • Phone: 617-909-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number1453090
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: