Individual
KIM OMALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC T
Contact information
Practice address
764 E 176TH ST, BRONX, NY 10460-4606
(718) 542-8770
Mailing address
764 E 176TH ST, BRONX, NY 10460-4606
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
39943
—
Other
Enumeration date
05/19/2025
Last updated
05/19/2025
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