Provider Demographics
NPI:1407947989
Name:MALLEN, ANNETTE S (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:S
Last Name:MALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:S
Other - Last Name:LEMIEUX-ST.GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-3808
Mailing Address - Country:US
Mailing Address - Phone:508-942-1103
Mailing Address - Fax:781-396-1439
Practice Address - Street 1:151 MYSTIC AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-4632
Practice Address - Country:US
Practice Address - Phone:781-396-1199
Practice Address - Fax:781-396-1439
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207323101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health