Provider Demographics
NPI:1457717506
Name:KATHLEEN KELLY MALONE, LCSW LLC
Entity Type:Organization
Organization Name:KATHLEEN KELLY MALONE, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:914-450-7695
Mailing Address - Street 1:1 DELL LANE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502
Mailing Address - Country:US
Mailing Address - Phone:914-450-7695
Mailing Address - Fax:914-693-4175
Practice Address - Street 1:1 DELL LANE
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502
Practice Address - Country:US
Practice Address - Phone:914-450-7695
Practice Address - Fax:914-693-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-028357-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7430Medicare UPIN