Healthcare Provider Details

I. General information

NPI: 1497921878
Provider Name (Legal Business Name): RITA P. O'MALLEY M.A., L.D.T/C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 CHURCH ST
BELFORD NJ
07718-1057
US

IV. Provider business mailing address

417 CHURCH ST
BELFORD NJ
07718-1057
US

V. Phone/Fax

Practice location:
  • Phone: 732-284-0619
  • Fax: 732-495-3627
Mailing address:
  • Phone: 732-284-0619
  • Fax: 732-495-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSTUDENT
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: