Provider Demographics
NPI:1730592262
Name:DEODHARI, MALA DEVI (LCSW)
Entity type:Individual
Prefix:
First Name:MALA
Middle Name:DEVI
Last Name:DEODHARI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 NORTHUMBERLAND WAY
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-2374
Mailing Address - Country:US
Mailing Address - Phone:732-991-1556
Mailing Address - Fax:
Practice Address - Street 1:1520 NORTHUMBERLAND WAY
Practice Address - Street 2:
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-2374
Practice Address - Country:US
Practice Address - Phone:732-991-1556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055638001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical