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Individual

MS. DIANE MALLACH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
50 NEWARK AVE, #306, BELLEVILLE, NJ 07109
(973) 450-0220
(973) 450-0162
Mailing address
PO BOX 71, MAPLEWOOD, NJ 07040
(201) 787-7142
(973) 450-0162

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC00284200
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
7081448
AETNA
01
P3470927
OXFORD
Enumeration date
09/22/2006
Last updated
07/08/2007
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