Provider Demographics
NPI:1639907983
Name:CHRISTMAN, MALLORY JUSTINE (PSYD)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:JUSTINE
Last Name:CHRISTMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 VIA DOLOROSA DR
Mailing Address - Street 2:
Mailing Address - City:BLANDON
Mailing Address - State:PA
Mailing Address - Zip Code:19510-9692
Mailing Address - Country:US
Mailing Address - Phone:610-301-3571
Mailing Address - Fax:
Practice Address - Street 1:501 W 14TH ST FL 6
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1013
Practice Address - Country:US
Practice Address - Phone:302-320-1300
Practice Address - Fax:302-320-1373
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020165103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist