Provider Demographics
NPI:1154926384
Name:MALONE, LAURA (LCSQ)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:LCSQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 SAWMILL RD
Mailing Address - Street 2:BLDG 10B. APT.201
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70123
Mailing Address - Country:US
Mailing Address - Phone:504-645-0191
Mailing Address - Fax:
Practice Address - Street 1:2100 SAWMILL RD BLDG10B
Practice Address - Street 2:APT .201
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70123
Practice Address - Country:US
Practice Address - Phone:504-495-7684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical