Provider Demographics
NPI:1588090138
Name:MALLORY, KARI MICHELLE (MSW, LSW, ACM)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:MICHELLE
Last Name:MALLORY
Suffix:
Gender:F
Credentials:MSW, LSW, ACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4337 UNION RD
Mailing Address - Street 2:SOCIAL WORKER
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5211
Mailing Address - Country:US
Mailing Address - Phone:513-423-8387
Mailing Address - Fax:513-423-3309
Practice Address - Street 1:4337 UNION RD
Practice Address - Street 2:SOCIAL WORKER
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5211
Practice Address - Country:US
Practice Address - Phone:513-423-8387
Practice Address - Fax:513-423-3309
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-15
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0031277104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker