Provider Demographics
NPI:1336225143
Name:MALONE, JOSEPHINE ANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ANNETTE
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:PO BOX 890487
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-0487
Mailing Address - Country:US
Mailing Address - Phone:713-882-9114
Mailing Address - Fax:
Practice Address - Street 1:16821 BUCCANEER LN
Practice Address - Street 2:SUITE 206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2544
Practice Address - Country:US
Practice Address - Phone:713-882-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255551041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R518Medicare PIN
TX8J3786Medicare PIN