Healthcare Provider Details

I. General information

NPI: 1104196609
Provider Name (Legal Business Name): MICHAEL PATRICK O'MARA LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2011
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 GOFF AVE UNIT 4208
PAWTUCKET RI
02860-8406
US

IV. Provider business mailing address

40 MONTGOMERY ST UNIT 3
PAWTUCKET RI
02862-7702
US

V. Phone/Fax

Practice location:
  • Phone: 401-369-7093
  • Fax: 888-977-2519
Mailing address:
  • Phone: 401-369-7093
  • Fax: 888-977-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00626
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC11884
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: