Provider Demographics
NPI:1518475847
Name:MALLOY, MARITZA ISADORA (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:ISADORA
Last Name:MALLOY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 DEEPWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-4612
Mailing Address - Country:US
Mailing Address - Phone:216-551-2726
Mailing Address - Fax:
Practice Address - Street 1:2279 ROMIG RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3823
Practice Address - Country:US
Practice Address - Phone:330-253-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1800917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health