Mallory Lynne Mizvitowicz, CRNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

SP028758 Issued in PA

Practice address

2002 Sproul Rd FL 3
Broomall, PA 19008-3510

Phone

(610) 626-8085

NPI assigned

Feb 29, 2024

Last updated

Feb 29, 2024By 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 PA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Psych Choices of the Delaware Valley, LLCGroup PAC ID 9133483688, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Psych Choices of the Delaware Valley, LLC

  • Professional Counselor
  • Drexel Hill, PA
  • NPI 1194213892

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709164800000",
    "number": "1427815042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 W DUPONT ST",
            "city": "RIDLEY PARK",
            "state": "PA",
            "postal_code": "190783207",
            "telephone_number": "215-605-9015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 SPROUL RD FL 3",
            "city": "BROOMALL",
            "state": "PA",
            "postal_code": "190083510",
            "telephone_number": "610-626-8085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIZVITOWICZ",
        "first_name": "MALLORY",
        "middle_name": "LYNNE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP028758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Jane Miller
• Shivaun Miller
• Susan Miller, MD
• Mind Over Mood LLC
• Ericka N Mitchell
• Molly Elizabeth Modica, LMFT
• Mark A. Monaco, D.O.
• Brenna Catherine Montgomery, BEHAVIOR TECHNICIAN
• Lauren Farrell Moran, M.S., OTR/L
• Paras Mori, PHARMD

• Psychiatric/Mental Health Nurse Practitioner in Broomall, PA
• Providers in Broomall, PA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.