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NPI Code Detail

MEDICARE: PAMELA MALLOY MA, NCC, LPC

MEDICARE: PAMELA MALLOY MA, NCC, LPC
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
1101YP2500XProfessional Counselor37PC00326900NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
137PC00326900OTHERNJLPC

General Provider Information

NPI Number : 1710041108
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA MALLOY MA, NCC, LPC
Provider Business Mailing Address
First Line : 1 PAINTED WAGON RD
Second Line :
City : HOLMDEL
State : NJ
Zip : 07733-2725
Country : US
Telephone Number : 732-706-1461
Fax Number :
Provider Business Practice Location Address
First Line : 166 MAIN ST
Second Line :
City : MATAWAN
State : NJ
Zip : 07747-3104
Country : US
Telephone Number : 732-290-9040
Fax Number : 732-566-0433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 07/08/2007

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