Provider Demographics
NPI:1366566978
Name:MALLOW, KATHY L (MSW)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:L
Last Name:MALLOW
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 BLOOMFIELD ST
Mailing Address - Street 2:#2
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4911
Mailing Address - Country:US
Mailing Address - Phone:201-222-1869
Mailing Address - Fax:
Practice Address - Street 1:132 WASHINGTON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4646
Practice Address - Country:US
Practice Address - Phone:201-222-1869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC008708001041C0700X
NY0450461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ845173Medicare ID - Type Unspecified