Provider Demographics
NPI:1639393358
Name:DULLAGHAN, CAMILLE LUCILLE
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:LUCILLE
Last Name:DULLAGHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAMILLE
Other - Middle Name:LUCILLE
Other - Last Name:DULLAGHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:105 TIERNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009
Mailing Address - Country:US
Mailing Address - Phone:973-239-2359
Mailing Address - Fax:973-482-2870
Practice Address - Street 1:125 VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:973-865-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO04249100363LP0808X
CA784068163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health