Provider Demographics
NPI:1417160037
Name:MALLOY, CARLTON L (MSW,CAC,LADC,CCDP-D)
Entity Type:Individual
Prefix:MR
First Name:CARLTON
Middle Name:L
Last Name:MALLOY
Suffix:
Gender:M
Credentials:MSW,CAC,LADC,CCDP-D
Other - Prefix:MISS
Other - First Name:CARLTON
Other - Middle Name:LEE
Other - Last Name:MALLOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW,CAC,LADC,CCDP-D
Mailing Address - Street 1:30 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3906
Mailing Address - Country:US
Mailing Address - Phone:860-347-3682
Mailing Address - Fax:860-347-3682
Practice Address - Street 1:30 SILVER ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3906
Practice Address - Country:US
Practice Address - Phone:860-334-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker