Provider Demographics
NPI:1205123825
Name:MALONEY, BLAND DEW (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:BLAND
Middle Name:DEW
Last Name:MALONEY
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 1:1216 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2672
Mailing Address - Country:US
Mailing Address - Phone:860-521-2144
Mailing Address - Fax:860-236-4811
Practice Address - Street 1:1216 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2672
Practice Address - Country:US
Practice Address - Phone:860-521-2144
Practice Address - Fax:860-236-4811
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-03
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001330101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health