Janis Carol Mallon, PH.D.

Key facts

NPI

1407065360

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Psychologist 103TC0700X

License

PS692 (ME)

Practice address

26 Edes Rd
Cumberland, ME 04021-4101

Phone

(207) 829-6912

NPI assigned

May 21, 2007

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Philosophy

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407065360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 EDES RD",
            "city": "CUMBERLAND",
            "state": "ME",
            "postal_code": "040214101",
            "telephone_number": "207-829-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 EDES RD",
            "city": "CUMBERLAND",
            "state": "ME",
            "postal_code": "040214101",
            "telephone_number": "207-829-6912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLON",
        "first_name": "JANIS",
        "middle_name": "CAROL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ME",
            "license": "PS692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mary E McCann, ED.D
• Elizabeth Anne McCarthy, LCSW
• Xanthe Moss
• Msad #51

All providers in Cumberland, ME · Clinical Psychologist in Maine