Provider Demographics
NPI:1164720801
Name:MALLEOLO, ERIN E
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:MALLEOLO
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 1:79 VASSAR RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5450
Mailing Address - Country:US
Mailing Address - Phone:914-489-1261
Mailing Address - Fax:
Practice Address - Street 1:79 VASSAR RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-5450
Practice Address - Country:US
Practice Address - Phone:914-489-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0-11-4009103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst