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General NPI Number Information
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NPI Number | 1023141850
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Entity Type | Individual
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Provider Name | SHARON M MALLOY LCSW LICENSED CLINIC
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 10/20/2010
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Provider Practice Location Address
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Address Line | 3020 WAIALAE AVE
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City | HONOLULU
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State | HI
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Zip | 96816-1506
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Country | US
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Telephone | 808-791-9376
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Fax |
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Provider Business Mailing Address
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Address Line | 277 OHUA AVE
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City | HONOLULU
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State | HI
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Zip | 96815-6612
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Country | US
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Telephone | 808-791-9355
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Fax | 808-791-9355
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 989618
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License Number State | CO
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