Provider Demographics
NPI:1477095859
Name:MALCOLM, ROSE CATRIONA (LPC)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:CATRIONA
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7092 PARMA PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-5008
Mailing Address - Country:US
Mailing Address - Phone:440-334-6368
Mailing Address - Fax:
Practice Address - Street 1:601 SR 224
Practice Address - Street 2:
Practice Address - City:GLANDORF
Practice Address - State:OH
Practice Address - Zip Code:45848
Practice Address - Country:US
Practice Address - Phone:419-538-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1400669101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0358325Medicaid