Provider Demographics
NPI:1770067720
Name:O'MALLEY, HEATHER (ASW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1750 PRAIRIE CITY RD
Mailing Address - Street 2:SUITE 130, #636
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:925-352-5214
Mailing Address - Fax:
Practice Address - Street 1:420 ELLIS CIR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-9571
Practice Address - Country:US
Practice Address - Phone:925-352-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X, 1041C0700X
CA1251001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker