Provider Demographics
NPI:1881648269
Name:MALONE, MAUREEN E (LICSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:MALONE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WASHINGTON ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2017
Mailing Address - Country:US
Mailing Address - Phone:603-818-6288
Mailing Address - Fax:
Practice Address - Street 1:16 ROUTE 111
Practice Address - Street 2:BUILDING 2 SUITE 5
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-4142
Practice Address - Country:US
Practice Address - Phone:603-818-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30426031Medicaid
NH30426031Medicaid