Provider Demographics
NPI:1063478642
Name:MOLONEY, MAUREEN (LMSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MOLONEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 BELLE CHASE WAY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911
Mailing Address - Country:US
Mailing Address - Phone:517-882-3732
Mailing Address - Fax:517-882-3633
Practice Address - Street 1:3475 BELLE CHASE WAY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911
Practice Address - Country:US
Practice Address - Phone:517-882-3732
Practice Address - Fax:517-882-3633
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010195561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C36171022Medicare ID - Type UnspecifiedMEDICARE