Healthcare Provider Details

I. General information

NPI: 1073540142
Provider Name (Legal Business Name): ANITA L MALLICONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ANITA L SMITH

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NEW SALEM RD SUITE 116
UNIONTOWN PA
15401-8936
US

IV. Provider business mailing address

100 NEW SALEM RD SUITE 116
UNIONTOWN PA
15401-8936
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-0729
  • Fax: 724-437-2761
Mailing address:
  • Phone: 724-437-0729
  • Fax: 724-437-2761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013267
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier2755395
Identifier TypeOTHER
Identifier State
Identifier IssuerMAGELLAN
# 2
Identifier160263
Identifier TypeOTHER
Identifier State
Identifier IssuerTRICARE
# 3
Identifier879199
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: