Provider Demographics
NPI:1275205049
Name:MALLINSON, MARY DANG (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DANG
Last Name:MALLINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2650 CAMINO DEL RIO N STE 305
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1632
Mailing Address - Country:US
Mailing Address - Phone:619-363-1920
Mailing Address - Fax:
Practice Address - Street 1:2650 CAMINO DEL RIO N STE 305
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1632
Practice Address - Country:US
Practice Address - Phone:619-363-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1010451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical