Provider Demographics
NPI:1558433110
Name:FRAWLEY-O'DEA, MARY GAIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY GAIL
Middle Name:
Last Name:FRAWLEY-O'DEA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 CADAGON CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-0006
Mailing Address - Country:US
Mailing Address - Phone:704-814-9352
Mailing Address - Fax:
Practice Address - Street 1:9930 MONROE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5344
Practice Address - Country:US
Practice Address - Phone:704-814-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3247103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical