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General NPI Number Information
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NPI Number | 1841058252
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Entity Type | Organization
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Legal Business Name | DR MALLORY DIMLER PA
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 37 KINGS RD STE 203
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City | MADISON
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State | NJ
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Zip | 07940-2500
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Country | US
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Telephone | 617-819-5981
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Fax |
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Provider Business Mailing Address
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Address Line | 37 KINGS RD STE 203
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City | MADISON
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State | NJ
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Zip | 07940-2500
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Country | US
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Telephone | 617-819-5981
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | MALLORY DIMLER
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Credential | PHD
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Telephone | 617-819-5981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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