Provider Demographics
NPI:1386252559
Name:MALO, MARYANN
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:MALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 LOG PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1027
Mailing Address - Country:US
Mailing Address - Phone:141-351-2959
Mailing Address - Fax:
Practice Address - Street 1:188 LOG PLAIN RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1027
Practice Address - Country:US
Practice Address - Phone:413-512-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty