Provider Demographics
NPI:1508159476
Name:MALLONEE, BRENNAN C (LMHC)
Entity Type:Individual
Prefix:
First Name:BRENNAN
Middle Name:C
Last Name:MALLONEE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CHESTER STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-3001
Mailing Address - Country:US
Mailing Address - Phone:617-207-4077
Mailing Address - Fax:617-207-4077
Practice Address - Street 1:53 CHESTER STREET
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-3001
Practice Address - Country:US
Practice Address - Phone:617-207-4077
Practice Address - Fax:617-207-4077
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health