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NPI Code Detail

MEDICARE: JOHN A MALLINEN M.A., LPC

MEDICARE: JOHN A MALLINEN M.A., LPC
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1801184882
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN A MALLINEN M.A., LPC
Provider Business Mailing Address
First Line : 6701 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19126-2837
Country : US
Telephone Number : 215-276-3922
Fax Number :
Provider Business Practice Location Address
First Line : 6701 N BROAD ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19126-2837
Country : US
Telephone Number : 215-276-3922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2011
Last Update Date : 11/22/2013

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