Healthcare Provider Details

I. General information

NPI: 1871097519
Provider Name (Legal Business Name): DANIEL MALLOY-GOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 DARBY RD STE E4
PAOLI PA
19301
US

IV. Provider business mailing address

1447 ASPEN CT
WEST CHESTER PA
19380-2116
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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DANIEL MALLOY-GOOD
Title or Position: OWNER
Credential: LCSW
Phone: 484-321-6156