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Individual
MALLORY RUTH AXELROD
Active
Individual
MALLORY RUTH AXELROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
149.017634
IL
1041C0700X
Clinical Social Worker
ASW69967
CA
1041C0700X
Clinical Social Worker
Primary
LCSW72307
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922136076
—
CA
Enumeration date
01/07/2016
Last updated
11/20/2019
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