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General NPI Number Information
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NPI Number | 1346706884
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Entity Type | Individual
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Provider Name | NICOLE L MALLIARD LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 02/20/2019
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Provider Practice Location Address
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Address Line | 1654 W ONONDAGA ST
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City | SYRACUSE
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State | NY
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Zip | 13204-3318
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Country | US
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Telephone | 315-424-1845
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Fax |
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Provider Business Mailing Address
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Address Line | 401 PECK RD TRLR 56
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City | KIRKVILLE
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State | NY
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Zip | 13082-9604
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Country | US
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Telephone | 315-447-8010
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 093873
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License Number State | NY
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