Individual
MRS. KELLY ANN O MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LICSW
Contact information
Practice address
21 PEACE ST, PROVIDENCE, RI 02907
(401) 456-4358
Mailing address
200 HIGH SERVICE AVENUE, N PROVIDENCE, RI 02904
(401) 456-3649
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
ISW01883
RI
Other
Enumeration date
10/05/2006
Last updated
11/26/2007
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