Provider Demographics
NPI:1023162245
Name:MAURA K MALLOY PSYD PA
Entity type:Organization
Organization Name:MAURA K MALLOY PSYD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:MALLOY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:561-533-3903
Mailing Address - Street 1:1375 GATEWAY BLVD # 57
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8304
Mailing Address - Country:US
Mailing Address - Phone:561-533-3903
Mailing Address - Fax:561-244-5149
Practice Address - Street 1:1375 GATEWAY BLVD # 57
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8304
Practice Address - Country:US
Practice Address - Phone:561-533-3903
Practice Address - Fax:561-244-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004985103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59491OtherBCBS DR. MALLOY #
FL59491Medicare ID - Type UnspecifiedDR. MALLOY MEDICARE #