Provider Demographics
NPI:1043283682
Name:MALMON, CATHY S (LSW)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:S
Last Name:MALMON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 ELM ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3134
Mailing Address - Country:US
Mailing Address - Phone:724-543-1043
Mailing Address - Fax:724-545-1857
Practice Address - Street 1:200 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 240
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7132
Practice Address - Country:US
Practice Address - Phone:724-543-1043
Practice Address - Fax:724-545-1857
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW012778L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA169044OtherVALUE OPTIONS