Provider Demographics
NPI:1497804629
Name:MALONE, JUDITH A (PHD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:MALONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17123 FERNWAY RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3323
Mailing Address - Country:US
Mailing Address - Phone:216-295-8420
Mailing Address - Fax:
Practice Address - Street 1:8223 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1371
Practice Address - Country:US
Practice Address - Phone:440-526-4426
Practice Address - Fax:440-526-7961
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical