MEDICARE: DR. ALISSA MALLOW DSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R30323	NY
2	1041C0700X	Clinical Social Worker
3	1041C0700X	Clinical Social Worker	030323	NY

General Provider Information

NPI Number	:	1134281694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISSA MALLOW DSW, LCSW

Provider Business Mailing Address
First Line	:	169 MADISON AVE UNIT 15710
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-5101
Country	:	US
Telephone Number	:	516-526-8318
Fax Number	:

Provider Business Practice Location Address
First Line	:	7261 MOROCCA LAKE DR
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-3779
Country	:	US
Telephone Number	:	516-526-8318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/06/2025

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