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General NPI Number Information
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NPI Number | 1881896579
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Entity Type | Individual
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Provider Name | JEFFREY CARL O'MALLEY L.C.S.W
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Gender | Male
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 300 FLATBUSH AVENUE BROOKLYN CENTER FOR PSYCHOTHERAPY
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City | BROOKLYN
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State | NY
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Zip | 11215-2363
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Country | US
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Telephone | 917-865-8438
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Fax |
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Provider Business Mailing Address
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Address Line | 80 5TH AVE SUITE 1408-2
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City | NEW YORK
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State | NY
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Zip | 10011-8002
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Country | US
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Telephone | 917-865-8438
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Fax |
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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 | 077388-1
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License Number State | NY
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