Provider Demographics
NPI:1629483045
Name:MALONE, JENNIFER (MFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NELLEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1197
Mailing Address - Country:US
Mailing Address - Phone:415-457-2487
Mailing Address - Fax:415-457-5687
Practice Address - Street 1:150 NELLEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1197
Practice Address - Country:US
Practice Address - Phone:415-457-2487
Practice Address - Fax:415-457-5687
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist