=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477050391
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANELLE K MALOCH PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2018
-----------------------------------------------------
Last Update Date | 05/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5908 BRYANT ST STE 5
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15206-1606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-885-4492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5908 BRYANT ST STE 5
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15206-1606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-807-8975
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PS018370
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------