Provider Demographics
NPI:1285961235
Name:O'MALLEY, BETH A (MSW, LCSW, ACSW)
Entity type:Individual
Prefix:PROF
First Name:BETH
Middle Name:A
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:MSW, LCSW, ACSW
Other - Prefix:PROF
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:BLANGIARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13 ARCADIA RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1742
Mailing Address - Country:US
Mailing Address - Phone:203-442-5279
Mailing Address - Fax:
Practice Address - Street 1:13 ARCADIA RD
Practice Address - Street 2:SUITE 17
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1742
Practice Address - Country:US
Practice Address - Phone:203-442-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0071721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical