Provider Demographics
NPI:1215537287
Name:MALLON, CAROLYN ROSA (APRN)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ROSA
Last Name:MALLON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:75 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4868
Mailing Address - Country:US
Mailing Address - Phone:603-852-0639
Mailing Address - Fax:603-250-2370
Practice Address - Street 1:112 PLEASANT ST STE 2B
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2931
Practice Address - Country:US
Practice Address - Phone:603-852-0639
Practice Address - Fax:603-250-2370
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2023-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH066040-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health