Provider Demographics
NPI:1114084795
Name:MALONE, WILLIAM J II
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:MALONE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7908 CINCINNATI DAYTON RD
Mailing Address - Street 2:SUITE SA
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-6630
Mailing Address - Country:US
Mailing Address - Phone:513-779-0383
Mailing Address - Fax:513-779-4710
Practice Address - Street 1:7908 CINCINNATI DAYTON RD
Practice Address - Street 2:SUITE SA
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6630
Practice Address - Country:US
Practice Address - Phone:513-779-0383
Practice Address - Fax:513-779-4710
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI17661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMASW06493Medicare ID - Type Unspecified