Provider Demographics
NPI:1154421071
Name:MALLON, SHARON D (PHD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:D
Last Name:MALLON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:D
Other - Last Name:KRAFT MALLON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:251 WESTBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426
Mailing Address - Country:US
Mailing Address - Phone:860-767-1277
Mailing Address - Fax:860-767-7712
Practice Address - Street 1:251 WESTBROOK RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426
Practice Address - Country:US
Practice Address - Phone:860-767-1277
Practice Address - Fax:860-767-7712
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002528103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical