Individual
LYNETTE L MALLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
14300 GALLANT FOX LN STE 107, BOWIE, MD 20715-4031
(410) 562-6109
Mailing address
181 S SOUTHWOOD AVE, ANNAPOLIS, MD 21401-4025
(410) 562-6109
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
01817
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
409366600
—
MD
01
—
41737902
CAREFIRST RENDERING
MD
01
—
7704770
AETNA
MD
01
—
M3280009
BC/BS NAT'L CAPITAL REGIO
DC
Enumeration date
06/07/2006
Last updated
02/13/2019
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