Basic Information
| Provider Information | |||||||||
| NPI: | 1881342541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOND | ||||||||
| FirstName: | MALLORY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1247 CINNABAR WAY | ||||||||
| Address2: | |||||||||
| City: | VACAVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956877837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096103141 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3200 ADELINE ST | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947032407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106010203 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2022 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YS0200X | N | Behavioral Health & Social Service Providers | Counselor | School | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 172V00000X | N | Other Service Providers | Community Health Worker | 1041C0700X | 106640 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.