Healthcare Provider Details

I. General information

NPI: 1578784252
Provider Name (Legal Business Name): MARIA MALLOY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 S MONTANA ST
BUTTE MT
59701-2840
US

IV. Provider business mailing address

227 E MERCURY
BUTTE MT
59701
US

V. Phone/Fax

Practice location:
  • Phone: 406-533-2972
  • Fax:
Mailing address:
  • Phone: 406-782-2042
  • Fax: 406-782-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: