Provider Demographics
NPI:1225139579
Name:MALLOY, RONALD JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAY
Last Name:MALLOY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 FREMONT AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030
Mailing Address - Country:US
Mailing Address - Phone:626-403-8389
Mailing Address - Fax:626-799-0033
Practice Address - Street 1:1138 FREMONT AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030
Practice Address - Country:US
Practice Address - Phone:626-403-8389
Practice Address - Fax:626-799-0033
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5561103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist