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General NPI Number Information
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NPI Number | 1518475847
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Entity Type | Individual
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Provider Name | MARITZA ISADORA MALLOY LPCC-S
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Gender | Female
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 6802 W SNOWVILLE RD STE B
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City | BRECKSVILLE
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State | OH
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Zip | 44141-3296
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Country | US
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Telephone | 216-468-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 6802 W SNOWVILLE RD
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City | BRECKSVILLE
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State | OH
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Zip | 44141-3295
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Country | US
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Telephone | 216-551-2726
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.2001727-SUPV
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License Number State | OH
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