Provider Demographics
NPI:1881974798
Name:CLOKE, MALLORY ALEXANDRA
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:ALEXANDRA
Last Name:CLOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 FANEUIL ST # 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1844
Mailing Address - Country:US
Mailing Address - Phone:203-417-4899
Mailing Address - Fax:
Practice Address - Street 1:259 FANEUIL ST # 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1844
Practice Address - Country:US
Practice Address - Phone:203-417-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker