Provider Demographics
NPI:1063725026
Name:O'MALLEY, LAURA B
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:B
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MINOT PL
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1308
Mailing Address - Country:US
Mailing Address - Phone:617-283-4971
Mailing Address - Fax:
Practice Address - Street 1:460 TOTTEN POND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1991
Practice Address - Country:US
Practice Address - Phone:781-895-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst