Healthcare Provider Details

I. General information

NPI: 1558433110
Provider Name (Legal Business Name): MARY GAIL FRAWLEY-O'DEA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 MONROE RD SUITE 130
MATTHEWS NC
28105-5344
US

IV. Provider business mailing address

2617 CADAGON CT
CHARLOTTE NC
28270-0006
US

V. Phone/Fax

Practice location:
  • Phone: 704-814-9352
  • Fax:
Mailing address:
  • Phone: 704-814-9352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3247
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: