Provider Demographics
NPI:1417591439
Name:INSELBERG-ANDRUS, MALLORY (PSYD)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:INSELBERG-ANDRUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000D LAKE ST
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1295
Mailing Address - Country:US
Mailing Address - Phone:201-639-4032
Mailing Address - Fax:
Practice Address - Street 1:1000 LAKE ST STE D
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1249
Practice Address - Country:US
Practice Address - Phone:201-639-4032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTP233-081103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical