Provider Demographics
NPI:1831239136
Name:MALONEY, MARY ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:MALONEY
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 1:503 LONGRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-2051
Mailing Address - Country:US
Mailing Address - Phone:412-563-3451
Mailing Address - Fax:
Practice Address - Street 1:701 WASHINGTON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-2023
Practice Address - Country:US
Practice Address - Phone:412-512-8549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0148151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1437483OtherHIGHMARK