Provider Demographics
NPI:1508925884
Name:MALLOY, WILLIAM SMITH JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SMITH
Last Name:MALLOY
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-0422
Mailing Address - Country:US
Mailing Address - Phone:906-932-2641
Mailing Address - Fax:
Practice Address - Street 1:103 WEST U.S. 2
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MI
Practice Address - Zip Code:49968
Practice Address - Country:US
Practice Address - Phone:906-229-6120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010159131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801015913OtherCLINICAL SOCIAL WORKER
WI2087-123OtherCLINICAL SOCIAL WORK