Healthcare Provider Details

I. General information

NPI: 1518421130
Provider Name (Legal Business Name): KEVIN MALLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date: 10/04/2022
Reactivation Date: 10/18/2022

III. Provider practice location address

5541 WALNUT ST STE 300
PITTSBURGH PA
15232-2352
US

IV. Provider business mailing address

5855 DARLINGTON RD APT A1
PITTSBURGH PA
15217-1630
US

V. Phone/Fax

Practice location:
  • Phone: 412-246-2735
  • Fax:
Mailing address:
  • Phone: 724-263-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: