Provider Demographics
NPI:1790120921
Name:ELDREDGE, MALCOLM JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:JAMES
Last Name:ELDREDGE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1205 GRAMPIAN BLVD
Practice Address - Street 2:SUITE 3C
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1970
Practice Address - Country:US
Practice Address - Phone:570-320-7800
Practice Address - Fax:570-320-7801
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0177571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical