Provider Demographics
NPI:1063583011
Name:MALLON, PATRICIA M (RN, NPP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:M
Last Name:MALLON
Suffix:
Gender:F
Credentials:RN, NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 LANGPAP RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-9713
Mailing Address - Country:US
Mailing Address - Phone:585-582-1255
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY COUNSELING CENTER
Practice Address - Street 2:BOX 270356
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14627
Practice Address - Country:US
Practice Address - Phone:585-275-3113
Practice Address - Fax:585-442-0815
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299166-1163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY31104Y-URMedicare UPIN