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NPI Code Detail

MEDICARE: ABIGAIL MALLEY LCSW

MEDICARE: ABIGAIL MALLEY LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
21041C0700XClinical Social Worker2020025185MO

General Provider Information

NPI Number : 1649708132
Entity Type Code : Individual
Provider Name (Legal Business Name) : ABIGAIL MALLEY LCSW
Provider Business Mailing Address
First Line : 5954 WATERMAN BLVD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63112-1518
Country : US
Telephone Number : 970-988-3576
Fax Number :
Provider Business Practice Location Address
First Line : 12141 LADUE RD
Second Line :
City : CREVE COEUR
State : MO
Zip : 63141-8120
Country : US
Telephone Number : 314-878-4340
Fax Number : 314-878-4524
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2017
Last Update Date : 09/10/2020

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Directions to “ ABIGAIL MALLEY LCSW” Practice Location

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