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Individual
MS. MARY FAIRBANK O'MEARA
Active
Individual
MS. MARY FAIRBANK O'MEARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904001386
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055399
ANTHEM
VA
01
—
086605
SOUTHERN HEALTH
VA
01
—
2993306
MAMSI
VA
01
—
A308770
VALUE OPTIONS
VA
01
—
J6WCXB
WWT
VA
01
—
O86605
SENTARA
VA
Enumeration date
07/09/2006
Last updated
07/08/2007
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