Provider Demographics
NPI:1639515208
Name:MALLEY, TONI JOAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:TONI
Middle Name:JOAN
Last Name:MALLEY
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 1:10D WIGGINS FARM DR
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-3124
Mailing Address - Country:US
Mailing Address - Phone:860-651-5530
Mailing Address - Fax:
Practice Address - Street 1:46 W AVON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3679
Practice Address - Country:US
Practice Address - Phone:860-673-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional