Provider Demographics
NPI:1356516132
Name:MALLORY-POWELL, MARGARET LESLIE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:LESLIE
Last Name:MALLORY-POWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 BEAR DEN RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5230
Mailing Address - Country:US
Mailing Address - Phone:240-602-1107
Mailing Address - Fax:
Practice Address - Street 1:5480 WISCONSIN AVE STE 223
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3503
Practice Address - Country:US
Practice Address - Phone:301-576-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1000495103TC0700X
MD04522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200727420OtherTRICARE