LYNETTE L MALLOCH (NPI# 1225078710) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225078710 |
| Entity Type | Individual |
| Full Name | LYNETTE L MALLOCH |
| Credential | PHD |
| Practice Address |
14300 Gallant Fox Ln Ste 107 Bowie MD 20715-4031 |
| Mailing Address |
181 S Southwood Ave Annapolis MD 21401-4025 |
| Practice Telephone | 4105626109 |
| Mailing Telephone | 4105626109 |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2019-02-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
01817 | MD | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DC | BC/BS NAT'L CAPITAL REGIO | M3280009 | 01 |
| MD | 409366600 | 05 | |
| MD | AETNA | 7704770 | 01 |
| MD | CAREFIRST RENDERING | 41737902 | 01 |
| Street Address |
14300 GALLANT FOX LN STE 107 |
| City | BOWIE |
| State | MD |
| Zip Code | 20715-4031 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104304757 | Aynia V Dorsey | Occupational Therapist | 6915 Laurel Bowie Rd Ste 205b, Bowie, MD 20715 | 2018-08-04 |
| 1558852988 | Dmv Foot and Ankle Center | Podiatrist | 15480 Annapolis Rd Ste 202-437, Bowie, MD 20715 | 2018-05-22 |
| 1861918435 | Ryan Leigh Brown | Psychologist | 3231 Superior Lane, Suite, A6, Bowie, MD 20715 | 2017-08-16 |
| 1073060430 | Chinwendu Ezeoru | Nurse Practitioner | 13004 Viewpoint Ln, Bowie, MD 20715 | 2016-09-02 |
| 1386094977 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 15501 Annapolis Rd, Suite 400, Bowie, MD 20715 | 2016-06-15 |
| 1083003164 | Megan Elizabeth Cooper | Social Worker | 2812 Bosworth Ln, Bowie, MD 20715 | 2015-01-13 |
| 1467856740 | Nathan-todd Consulting | Community/Behavioral Health | 3231 Superior Court Lane,# A5, Bowie, MD 20715 | 2014-10-15 |
| 1841534468 | Varsity Professional Rehabilitation and Staffing, LLC | Physical Therapist | 14000 Jericho Park Road, Bowie, MD 20715 | 2012-11-20 |
| 1013269893 | Felix Chukwudi Ohams | Registered Nurse | 7613 Old Chapel Dr, Bowie, MD 20715 | 2012-10-04 |
| 1720336464 | Tara Marie Hatfield | Physical Therapist | 100 Whitemarsh Park Drive, Bowie, MD 20715 | 2012-08-28 |
| Find all providers in zip 20715 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972022929 | Kimberly M Brooks, Phd, Inc. | Psychologist | 3231 Superior Ln Ste A6, Bowie, MD 20715-1939 | 2017-09-11 |
| 1497125512 | Safe Harbor Christian Counseling | Psychologist | 15012 Narrows Ln, Bowie, MD 20716-1202 | 2015-10-01 |
| 1679943799 | Safe Harbor Christian Counseling | Psychologist | 15406 Jennings Ln, Bowie, MD 20721-7211 | 2015-10-01 |
| 1801218193 | Denise Daniels | Psychologist | 9700 Glenkirk Way, Bowie, MD 20721-2996 | 2014-01-06 |
| 1598109845 | Sheri Ann Wilson | Psychologist | 102 Jennings Mill Dr, Bowie, MD 20721-7260 | 2013-04-17 |
| 1528213287 | Cyndie Marie Buckson | Psychologist | 5200 Roberts Prospect Dr, Bowie, MD 20720-3378 | 2008-11-22 |
| 1932361391 | Renita Cherise Gabriel | Psychologist | 3060 Mitchellville Rd Ste 106, Bowie, MD 20716-1389 | 2008-06-27 |
| 1972635860 | Vallayil G Kurian | Psychologist | 16010 Annapolis Rd, Bowie, MD 20715 | 2007-03-09 |
| 1457409765 | Richard R Bebout | Psychologist | 12621 Kavanaugh Ln, Bowie, MD 20715-2816 | 2007-01-05 |
| 1821150525 | Mary Pasquella | Psychologist | 12661 Heming Ln, Bowie, MD 20716-1118 | 2006-12-16 |
| Find all providers in BOWIE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.