Provider Demographics
NPI:1922091727
Name:MALKOFF, SUSAN SR (LISW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MALKOFF
Suffix:SR
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MOTOR INN DR
Mailing Address - Street 2:SUITE #320
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-2420
Mailing Address - Country:US
Mailing Address - Phone:330-759-0707
Mailing Address - Fax:330-759-9708
Practice Address - Street 1:1601 MOTOR INN DR
Practice Address - Street 2:SUITE #320
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-2420
Practice Address - Country:US
Practice Address - Phone:330-759-0707
Practice Address - Fax:330-759-9708
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-10031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH055379OtherVALUE OPTIONS
OHIP126604OtherGREENSPRING
OH0239361Medicaid
OH000000115337OtherANTHEM
OHSW06481Medicare ID - Type Unspecified