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General NPI Number Information
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NPI Number | 1275005639
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Entity Type | Individual
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Provider Name | NICHOLAS ALEXANDER O'MEALLY LSW
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Gender | Male
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Dates
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Enumeration Date | 12/26/2018
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 8220 CASTOR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2729
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Country | US
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Telephone | 267-254-6884
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Fax | 215-728-4389
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Provider Business Mailing Address
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Address Line | 8220 CASTOR AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2729
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Country | US
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Telephone | 267-254-6884
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Fax | 215-728-4389
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW023448
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License Number State | PA
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