Provider Demographics
NPI:1932492899
Name:MALONE, PATRICIA G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:G
Last Name:MALONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4139 ATWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484-5249
Mailing Address - Country:US
Mailing Address - Phone:845-687-8707
Mailing Address - Fax:
Practice Address - Street 1:4139 ATWOOD RD
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484-5249
Practice Address - Country:US
Practice Address - Phone:845-687-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0773041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical