Bethany Mallory

Primary specialty

PsychologistTaxonomy code 103T00000X

License

P.08190 Issued in OH

Practice address

3085 Woodman Dr Ste 240
Kettering, OH 45420-1159

Phone

(937) 951-3077

Fax

(937) 951-3109

NPI assigned

Aug 17, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Children'S Hospital Medical Center

  • Pediatrics Physician
  • Cincinnati, OH
  • NPI 1609915784

  Psychologist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1043986540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3085 WOODMAN DR STE 240",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454201159",
            "telephone_number": "937-951-3077",
            "fax_number": "937-951-3109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3085 WOODMAN DR STE 240",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454201159",
            "telephone_number": "937-951-3077",
            "fax_number": "937-951-3109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "BETHANY",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-17",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "P.08190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Louise Makse, PHARMD
• Male Reproductive Medicine of Southwest Ohio
• Aamir I Malik, MD
• Sharal Mall, DO
• Joseph Lynn Mallios, LPN
• Meagan Elaine Maloney
• Lancing Paul Malusky, D.P.M.
• Allison Nicole Mancz
• Sara Mangas, NP-C
• Gregory Scott Mangen, DO

• Psychologist in Kettering, OH
• Providers in Kettering, OH by specialty
• Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.