Provider Demographics
NPI:1932873064
Name:MALLEY, DOROTEA C (CLC)
Entity type:Individual
Prefix:
First Name:DOROTEA
Middle Name:C
Last Name:MALLEY
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:THEA
Other - Middle Name:
Other - Last Name:MALLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CLC
Mailing Address - Street 1:44 CAMPO TER
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5301
Mailing Address - Country:US
Mailing Address - Phone:732-299-5079
Mailing Address - Fax:
Practice Address - Street 1:44 CAMPO TER
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5301
Practice Address - Country:US
Practice Address - Phone:732-299-5079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ328176174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN