Provider Demographics
NPI:1649481599
Name:MALONE, JOHN J (LCSW, CASAC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:MALONE
Suffix:
Gender:M
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROBERT LENNOX DR
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1035
Mailing Address - Country:US
Mailing Address - Phone:631-662-2747
Mailing Address - Fax:
Practice Address - Street 1:4 ROBERT LENNOX DR
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-1035
Practice Address - Country:US
Practice Address - Phone:631-662-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7654101YA0400X
NYR030324-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical