Provider Demographics
NPI:1760549083
Name:MALONEY, SARAH POND (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:POND
Last Name:MALONEY
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 1:1321 WASHINGTON AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3675
Mailing Address - Country:US
Mailing Address - Phone:207-233-0014
Mailing Address - Fax:
Practice Address - Street 1:205 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5712
Practice Address - Country:US
Practice Address - Phone:207-773-7993
Practice Address - Fax:207-773-5512
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC70391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME119820000Medicaid