Islam Mallory

Primary specialty

Social WorkerTaxonomy code 104100000X

License

0906013183 Issued in VA

Practice address

6048 John Jackson Dr
Williamsburg, VA 23188-7591

Phone

(757) 912-3665

NPI assigned

Mar 24, 2023

Last updated

Mar 24, 2023By the provider in NPPES

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

Enrolled in VA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mermaid Counseling and Consulting LLC

  • Mental Health Counselor
  • Norfolk, VA
  • NPI 1114694098
  Medicare reassignment NPD

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

{
    "created_epoch": "1679616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679616000000",
    "number": "1295438661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6048 JOHN JACKSON DR",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231887591",
            "telephone_number": "757-912-3665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6048 JOHN JACKSON DR",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231887591",
            "telephone_number": "757-912-3665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "ISLAM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-24",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "VA",
            "license": "0906013183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David J Maharty, D.M.D
• Siham Mohieldin Mahgoub, MD
• Kimberly Dianne Maigi, NP
• James Patrick Majdic, DO
• Adrian Mallicott, LPTA
• Laura Caitlin Mangelsdorf, LCSW
• Justin Mangold
• Lauren Maninga, LCSW
• Hannah Lee Manson, PA
• Patricia L Marcuson, M.D.

• Social Worker in Williamsburg, VA
• Providers in Williamsburg, VA by specialty
• Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; 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.