Provider Information for 1811446735
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COREY JAMIAN MALLETTE LCSW
Sex: Female
NPI: 1811446735
Last Updated: 2023-08-08
Certification Date: 2023-08-08
Certification Date: 2023-08-08
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1811446735 | ||||||||
| Enumeration Date | 2016-10-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2851 SKIPPER ST THE VILLAGES, FL 32163-0387 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 2851 SKIPPER ST THE VILLAGES, FL 32163-0387 United States Phone: 917-836-2646 | Fax: | ||||||||
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