Healthcare Provider Details

I. General information

NPI: 1710161922
Provider Name (Legal Business Name): LINDA O'MALLEY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NORTH MAIN STREET THE PROVIDENCE CENTER
PROVIDENCE RI
02904
US

IV. Provider business mailing address

528 NORTH MAIN STREET THE PROVIDENCE CENTER
PROVIDENCE RI
02904
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: