Healthcare Provider Details

I. General information

NPI: 1023141850
Provider Name (Legal Business Name): SHARON M MALLOY LCSW LICENSED CLINIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 WAIALAE AVE
HONOLULU HI
96816-1506
US

IV. Provider business mailing address

277 OHUA AVE
HONOLULU HI
96815-6612
US

V. Phone/Fax

Practice location:
  • Phone: 808-791-9376
  • Fax:
Mailing address:
  • Phone: 808-791-9355
  • Fax: 808-791-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number989618
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: