Provider Demographics
NPI:1073686622
Name:MALLOY, PAUL L (LSCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:MALLOY
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 COLLEGE BLVD.,
Mailing Address - Street 2:SUITE 304
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1760
Mailing Address - Country:US
Mailing Address - Phone:913-323-6560
Mailing Address - Fax:913-338-0428
Practice Address - Street 1:4500 COLLEGE BLVD.
Practice Address - Street 2:SUITE 304
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1760
Practice Address - Country:US
Practice Address - Phone:913-323-6560
Practice Address - Fax:913-338-0428
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW #7791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0002993Medicare PIN