Provider Demographics
NPI:1538634472
Name:MALLOY, TAMMY CHEEVER
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:CHEEVER
Last Name:MALLOY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:TAMMY
Other - Middle Name:CHEEVER
Other - Last Name:MALLOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCSW, CSAT
Mailing Address - Street 1:695 DIXIE LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-3623
Mailing Address - Country:US
Mailing Address - Phone:561-376-9790
Mailing Address - Fax:561-465-1041
Practice Address - Street 1:7777 GLADES RD STE 205
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4150
Practice Address - Country:US
Practice Address - Phone:561-376-9790
Practice Address - Fax:561-465-1041
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW124431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical