Provider Demographics
NPI:1912906801
Name:MALONE, MARGUERITE DEBORAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:DEBORAH
Last Name:MALONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CLEMENTS RD
Mailing Address - Street 2:
Mailing Address - City:COTTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35453-2137
Mailing Address - Country:US
Mailing Address - Phone:205-752-7691
Mailing Address - Fax:
Practice Address - Street 1:3200 CLEMENTS RD
Practice Address - Street 2:
Practice Address - City:COTTONDALE
Practice Address - State:AL
Practice Address - Zip Code:35453-2137
Practice Address - Country:US
Practice Address - Phone:205-752-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL489103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51071152Medicare UPIN