Healthcare Provider Details

I. General information

NPI: 1679942726
Provider Name (Legal Business Name): MALLORY CALLINAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 CHURCH AVE
WAREHAM MA
02571-2093
US

IV. Provider business mailing address

2421 CRANBERRY HWY STE 204
WAREHAM MA
02571-5032
US

V. Phone/Fax

Practice location:
  • Phone: 413-749-5770
  • Fax:
Mailing address:
  • Phone: 413-749-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: