Provider Demographics
NPI:1639595580
Name:MALONE, FREDERICA MELANIE (MAAT, ATR, LCPC)
Entity Type:Individual
Prefix:MS
First Name:FREDERICA
Middle Name:MELANIE
Last Name:MALONE
Suffix:
Gender:F
Credentials:MAAT, ATR, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 W ROOSEVELT RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1131
Mailing Address - Country:US
Mailing Address - Phone:312-382-2504
Mailing Address - Fax:312-236-5384
Practice Address - Street 1:2310 W ROOSEVELT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1131
Practice Address - Country:US
Practice Address - Phone:312-382-2504
Practice Address - Fax:312-236-5384
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional