Provider Demographics
NPI:1639149123
Name:O'DONNELL-MULGREW, DEBORAH M (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:M
Last Name:O'DONNELL-MULGREW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:M
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 E LAUREL RD
Mailing Address - Street 2:UDP #1100
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1354
Mailing Address - Country:US
Mailing Address - Phone:856-566-7036
Mailing Address - Fax:856-566-6108
Practice Address - Street 1:42 E LAUREL RD
Practice Address - Street 2:UDP #1100
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-7036
Practice Address - Fax:856-566-6108
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB068981002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0046752Medicaid
NJ0046752Medicaid