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General NPI Number Information
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NPI Number | 1538634472
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Entity Type | Individual
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Provider Name | TAMMY CHEEVER MALLOY
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Gender | Female
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Dates
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Enumeration Date | 10/08/2018
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 7777 GLADES RD STE 205
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City | BOCA RATON
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State | FL
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Zip | 33434-4150
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Country | US
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Telephone | 561-376-9790
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Fax | 561-465-1041
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Provider Business Mailing Address
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Address Line | 695 DIXIE LN
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-3623
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Country | US
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Telephone | 561-376-9790
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Fax | 561-465-1041
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW12443
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License Number State | FL
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