Provider Demographics
NPI:1669099404
Name:MALONE, SARA WICKS (LCSW)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:WICKS
Last Name:MALONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:WICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:391 ADELPHI ST APT C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1560
Mailing Address - Country:US
Mailing Address - Phone:917-478-8534
Mailing Address - Fax:
Practice Address - Street 1:1123 BROADWAY STE 319
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2093
Practice Address - Country:US
Practice Address - Phone:917-478-8534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076537-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical