Provider Demographics
NPI:1508913203
Name:MALONEY, MARTHA CAROLYN (LCPC-C, LADC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:CAROLYN
Last Name:MALONEY
Suffix:
Gender:F
Credentials:LCPC-C, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-4823
Mailing Address - Country:US
Mailing Address - Phone:207-474-8368
Mailing Address - Fax:207-474-7794
Practice Address - Street 1:5 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-4823
Practice Address - Country:US
Practice Address - Phone:207-474-8368
Practice Address - Fax:207-474-7794
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELX26011041S0200X
MELC5202101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool