Provider Demographics
NPI:1174862130
Name:MALONEY, ANNADORA S (LICSW)
Entity Type:Individual
Prefix:
First Name:ANNADORA
Middle Name:S
Last Name:MALONEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANNADORA
Other - Middle Name:CHRISTENER
Other - Last Name:SCANLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:48 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2430
Mailing Address - Country:US
Mailing Address - Phone:617-564-1499
Mailing Address - Fax:
Practice Address - Street 1:506 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1529
Practice Address - Country:US
Practice Address - Phone:617-564-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA1194961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health