Provider Demographics
NPI:1033463336
Name:MALONE, JUNE GELLIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:GELLIS
Last Name:MALONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 COTTAGE PL
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5227
Mailing Address - Country:US
Mailing Address - Phone:203-209-5595
Mailing Address - Fax:
Practice Address - Street 1:29 COTTAGE PL
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5227
Practice Address - Country:US
Practice Address - Phone:203-209-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8.001618103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical