Provider Demographics
NPI:1033239454
Name:MALONEY, MARTHA LINDSAY (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LINDSAY
Last Name:MALONEY
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MRS
Other - First Name:M
Other - Middle Name:LINDSAY
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:1730 W. 25TH STREET
Mailing Address - Street 2:MOB-2
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3108
Mailing Address - Country:US
Mailing Address - Phone:216-363-2122
Mailing Address - Fax:440-312-9251
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-5550
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00097841041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASW28401Medicare ID - Type Unspecified