Healthcare Provider Details

I. General information

NPI: 1417689118
Provider Name (Legal Business Name): MEGAN ELIZABETH MALLOY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 WILSON RD
BAKERSFIELD CA
93304-5319
US

IV. Provider business mailing address

3007 CHRISTMAS TREE LN
BAKERSFIELD CA
93306-1414
US

V. Phone/Fax

Practice location:
  • Phone: 661-328-4290
  • Fax:
Mailing address:
  • Phone: 816-582-0635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number133113
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133113
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number133113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: