Basic Information
| Provider Information | |||||||||
| NPI: | 1386918019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'MEARA | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | AMARAL | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 AVONDALE AVE | ||||||||
| Address2: | |||||||||
| City: | BILLERICA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018212406 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 61 MEDFORD ST | ||||||||
| Address2: | SOMERVILLE-CAMBRIDGE EARLY INTERVENTION | ||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021433421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176293919 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2012 | ||||||||
| LastUpdateDate: | 02/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 114609 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.