Provider Demographics
NPI:1245539147
Name:O'MALLEY, DEIRDRE (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:
Last Name:O'MALLEY
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 1:102 COLGATE ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2204
Mailing Address - Country:US
Mailing Address - Phone:201-562-0939
Mailing Address - Fax:
Practice Address - Street 1:1 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4404
Practice Address - Country:US
Practice Address - Phone:201-447-2242
Practice Address - Fax:201-447-4377
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4833103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist