Healthcare Provider Details

I. General information

NPI: 1609988971
Provider Name (Legal Business Name): DANIEL MALLOY-GOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DARBY RD STE F
PAOLI PA
19301
US

IV. Provider business mailing address

45 DARBY RD STE F
PAOLI PA
19301-1475
US

V. Phone/Fax

Practice location:
  • Phone: 484-321-6156
  • Fax:
Mailing address:
  • Phone: 484-321-6156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW005701L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: