Provider Demographics
NPI:1952829970
Name:ALLY, MALENA (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MALENA
Middle Name:
Last Name:ALLY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7507
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91409-7507
Mailing Address - Country:US
Mailing Address - Phone:818-276-9345
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD STE 555
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2607
Practice Address - Country:US
Practice Address - Phone:818-276-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0148061041C0700X
CALCSW722751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical