Provider Demographics
NPI:1912032046
Name:MALONE, JAMES DAVID (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAVID
Last Name:MALONE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:MR
Other - First Name:J
Other - Middle Name:DAVID
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:1190 STAFFORD RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721
Mailing Address - Country:US
Mailing Address - Phone:508-678-1180
Mailing Address - Fax:508-678-1184
Practice Address - Street 1:1190 STAFFORD RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721
Practice Address - Country:US
Practice Address - Phone:508-678-1180
Practice Address - Fax:508-678-1184
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1065731041C0700X
RIISW004181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7001111OtherAETNA
93972OtherBS OF RI
6208757OtherUNITED BEHAV HEALTH
P50100OtherBS OF MASS
1027020OtherBEACON HEALTH STRATEGIES
390745OtherMAGELLAN BEV HEALTH
410300OtherBLUE CROSS OF RI
7001111OtherAETNA