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General NPI Number Information
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NPI Number | 1518128131
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Entity Type | Individual
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Provider Name | KATHERINE OLIVIA MALLORY M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 4545 42ND ST NW SUITE 310
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City | WASHINGTON
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State | DC
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Zip | 20016
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Country | US
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Telephone | 917-833-6411
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Fax |
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Provider Business Mailing Address
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Address Line | 16 CHURCH ST STE 4
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City | LENOX
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State | MA
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Zip | 01240-2503
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Country | US
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Telephone | 413-551-2251
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 261459
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License Number State | MA
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