Provider Demographics
NPI:1801184882
Name:MALLINEN, JOHN A (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MALLINEN
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-2837
Mailing Address - Country:US
Mailing Address - Phone:215-276-3922
Mailing Address - Fax:
Practice Address - Street 1:6701 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19126-2837
Practice Address - Country:US
Practice Address - Phone:215-276-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker