Provider Demographics
NPI:1063569044
Name:MALOOLY, REBECCA ANN (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:MALOOLY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 LORING LN
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5006
Mailing Address - Country:US
Mailing Address - Phone:612-209-3161
Mailing Address - Fax:
Practice Address - Street 1:5600 LORING LN
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-5006
Practice Address - Country:US
Practice Address - Phone:651-439-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN126101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical