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General NPI Number Information
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NPI Number | 1003608324
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Entity Type | Individual
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Provider Name | MALLORY RICHERT PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 220 ABRAHAM FLEXNER WAY
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City | LOUISVILLE
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State | KY
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Zip | 40202-3826
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Country | US
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Telephone | 502-582-7484
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Fax |
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Provider Business Mailing Address
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Address Line | 2375 SIR BARTON WAY APT 2312
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City | LEXINGTON
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State | KY
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Zip | 40509-2568
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Country | US
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Telephone | 402-480-0216
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Fax | 402-480-0216
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 295748
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License Number State | KY
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