Provider Demographics
NPI:1982868121
Name:MALOOLY, MARY BROWN (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BROWN
Last Name:MALOOLY
Suffix:
Gender:F
Credentials:MFT
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 66
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91025-0066
Mailing Address - Country:US
Mailing Address - Phone:626-932-1015
Mailing Address - Fax:626-359-0877
Practice Address - Street 1:521 1/2 S MYRTLE AVE
Practice Address - Street 2:#6
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5189
Practice Address - Country:US
Practice Address - Phone:626-932-1015
Practice Address - Fax:626-359-0877
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist