Active NPI
Mallory Lynn Moody, LISW
- Clinical Social Worker
- Newark, OH
National Provider Identifier
1437667755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I.2103055
- Practice address
- 1616 W Church St Ste 1
Newark, OH 43055-1540 - Phone
- (740) 319-8695
- NPI assigned
- Jan 22, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.1903587 | OH | |
| Clinical Social Worker | 1041C0700X | I.2103055 | OH | Primary |
| Social Worker | 104100000X | S.1700236-TRNE | OH |
Addresses
Primary practice location
1616 W Church St Ste 1
Newark, OH 43055-1540
Mailing address
1616 W Church St Ste 1
Newark, OH 43055-1540
Phone (740) 319-8695
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0267430 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.1700236-TRNE | OH | MD | Social Worker |
| S.1903587 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634256000000",
"number": "1437667755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1616 W CHURCH ST STE 1",
"city": "NEWARK",
"state": "OH",
"postal_code": "430551540",
"telephone_number": "740-319-8695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1616 W CHURCH ST STE 1",
"city": "NEWARK",
"state": "OH",
"postal_code": "430551540",
"telephone_number": "740-319-8695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOODY",
"first_name": "MALLORY",
"middle_name": "LYNN",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-22",
"last_updated": "2021-10-15",
"certification_date": "2021-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.1903587",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "OH",
"license": "I.2103055",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.1700236-TRNE",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0267430",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.