Provider Demographics
NPI:1710018809
Name:MALCY, LISA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:MALCY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 SE 30TH AVE
Mailing Address - Street 2:23
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4444
Mailing Address - Country:US
Mailing Address - Phone:503-236-2213
Mailing Address - Fax:
Practice Address - Street 1:650 OFFICERS ROW
Practice Address - Street 2:SUITE B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3836
Practice Address - Country:US
Practice Address - Phone:360-513-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical