Provider Demographics
NPI:1194897454
Name:O'MEARA, MARIE ELLIOTT (LCSW)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ELLIOTT
Last Name:O'MEARA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 REDWING DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4121
Mailing Address - Country:US
Mailing Address - Phone:707-210-4418
Mailing Address - Fax:
Practice Address - Street 1:126 REDWING DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4121
Practice Address - Country:US
Practice Address - Phone:707-210-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical