Provider Demographics
NPI:1376604991
Name:MALLEY, BARBARA A (PSY D)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:A
Last Name:MALLEY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 DEERING ST
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733
Mailing Address - Country:US
Mailing Address - Phone:631-689-5788
Mailing Address - Fax:631-751-3465
Practice Address - Street 1:100 NORTH COUNTRY RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733
Practice Address - Country:US
Practice Address - Phone:631-751-3405
Practice Address - Fax:631-751-3465
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111161103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V78701OtherEMPIRE
EDI00572OtherIVANS USER NAME
NY01288137Medicaid
008640OtherEMPIRE ELECTRONIC SUBMITT
NYV7B701Medicare ID - Type Unspecified