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General NPI Number Information
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NPI Number | 1023162245
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Entity Type | Organization
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Legal Business Name | MAURA K MALLOY PSYD PA
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 1375 GATEWAY BLVD # 57
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8304
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Country | US
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Telephone | 561-533-3903
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Fax | 561-244-5149
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Provider Business Mailing Address
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Address Line | 1375 GATEWAY BLVD # 57
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8304
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Country | US
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Telephone | 561-533-3903
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Fax | 561-244-5149
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Authorized Official
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Title or Position | PRESIDENT & OWNER
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Name | MAURA KAYE MALLOY
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Credential | PSY.D.
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Telephone | 561-533-3903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY0004985
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License Number State | FL
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