Provider Demographics
NPI:1093505265
Name:MALLORY CRAIG PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:MALLORY CRAIG PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:802-752-8666
Mailing Address - Street 1:122 BERRY AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-9172
Mailing Address - Country:US
Mailing Address - Phone:802-752-8666
Mailing Address - Fax:
Practice Address - Street 1:122 BERRY AVE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-9172
Practice Address - Country:US
Practice Address - Phone:802-752-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty