Provider Demographics
NPI:1841058252
Name:DR MALLORY DIMLER PA
Entity type:Organization
Organization Name:DR MALLORY DIMLER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-819-5981
Mailing Address - Street 1:37 KINGS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2500
Mailing Address - Country:US
Mailing Address - Phone:617-819-5981
Mailing Address - Fax:
Practice Address - Street 1:37 KINGS RD STE 203
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2500
Practice Address - Country:US
Practice Address - Phone:617-819-5981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty