Provider Demographics
NPI:1356583595
Name:MALONE, SUSANNE MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:MARIE
Last Name:MALONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SUSANNE
Other - Middle Name:MARIE
Other - Last Name:LUEBKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3509 HULEN ST STE 106
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6800
Mailing Address - Country:US
Mailing Address - Phone:817-917-8512
Mailing Address - Fax:
Practice Address - Street 1:3509 HULEN ST STE 106
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6800
Practice Address - Country:US
Practice Address - Phone:817-917-8512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical