Provider Demographics
NPI:1972637148
Name:O'MALLEY, KERRI ANN (MED, CAGS)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:ANN
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:MED, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02532
Mailing Address - Country:US
Mailing Address - Phone:508-274-6025
Mailing Address - Fax:
Practice Address - Street 1:36 CORDAGE PARK CIR
Practice Address - Street 2:STE. 305A
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7331
Practice Address - Country:US
Practice Address - Phone:508-830-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor