Provider Demographics
NPI:1578923553
Name:MALONEY, LAUREN (MSCAP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MALONEY
Suffix:
Gender:F
Credentials:MSCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 SW BAYA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-4209
Mailing Address - Country:US
Mailing Address - Phone:386-754-9005
Mailing Address - Fax:386-754-9017
Practice Address - Street 1:922 SW BAYA DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-4209
Practice Address - Country:US
Practice Address - Phone:386-754-9005
Practice Address - Fax:386-754-9017
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM450525807551OtherDRIVERS LICENSE