Provider Demographics
NPI:1295881126
Name:REBECCA PERBIX MALLOS MSW INC
Entity type:Organization
Organization Name:REBECCA PERBIX MALLOS MSW INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:PERBIX
Authorized Official - Last Name:MALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:425-889-8524
Mailing Address - Street 1:8011 118TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033
Mailing Address - Country:US
Mailing Address - Phone:425-889-8524
Mailing Address - Fax:425-576-8274
Practice Address - Street 1:8011 118TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033
Practice Address - Country:US
Practice Address - Phone:425-889-8524
Practice Address - Fax:425-576-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000043461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty