Provider Demographics
NPI:1700820529
Name:MALOUF, REBECCA RIELY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:RIELY
Last Name:MALOUF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SE MAYNARD RD
Mailing Address - Street 2:STE 104
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511
Mailing Address - Country:US
Mailing Address - Phone:919-565-9622
Mailing Address - Fax:919-657-0017
Practice Address - Street 1:1350 SE MAYNARD RD
Practice Address - Street 2:STE 104
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511
Practice Address - Country:US
Practice Address - Phone:919-565-9622
Practice Address - Fax:919-657-0017
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0021521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical