Provider Demographics
NPI:1225148141
Name:MALONE, RACHELLE K (LCSW C)
Entity Type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:K
Last Name:MALONE
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-4708
Mailing Address - Country:US
Mailing Address - Phone:240-751-0381
Mailing Address - Fax:240-582-6841
Practice Address - Street 1:7676 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-7512
Practice Address - Country:US
Practice Address - Phone:240-485-1786
Practice Address - Fax:301-439-0008
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12009104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
014103 J37Medicare ID - Type Unspecified