Provider Demographics
NPI:1851866461
Name:JULIET MALONEY, LCSW, PLLC
Entity Type:Organization
Organization Name:JULIET MALONEY, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:716-207-8804
Mailing Address - Street 1:4639 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4925
Mailing Address - Country:US
Mailing Address - Phone:716-207-8804
Mailing Address - Fax:
Practice Address - Street 1:5500 MAIN ST STE 262
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6746
Practice Address - Country:US
Practice Address - Phone:716-207-8804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03106278Medicaid