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General NPI Number Information
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NPI Number | 1780039537
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Entity Type | Individual
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Provider Name | MALLORY MCINTOSH LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 600 MONTICELLO ST
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City | SOMERSET
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State | KY
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Zip | 42501-2974
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Country | US
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Telephone | 606-401-2966
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Fax | 606-244-4111
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Provider Business Mailing Address
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Address Line | 110 LIBERTY AVE
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City | BEREA
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State | KY
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Zip | 40403-1644
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Country | US
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Telephone | 606-401-2966
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Fax | 606-244-4111
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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 | LCSW00001168
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License Number State | KY
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