Provider Demographics
NPI:1396207239
Name:MALONEY, VERONICA LINDSAY
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:LINDSAY
Last Name:MALONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 E WILLIAM ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3782
Mailing Address - Country:US
Mailing Address - Phone:925-550-4902
Mailing Address - Fax:
Practice Address - Street 1:495 E WILLIAM ST APT 7
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3782
Practice Address - Country:US
Practice Address - Phone:925-550-4902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA93186551A45125Medicaid