Provider Demographics
NPI:1215046438
Name:MALONE, ANNE T (LCSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:T
Last Name:MALONE
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 1:36 E FRONT ST
Mailing Address - Street 2:#3
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2936
Mailing Address - Country:US
Mailing Address - Phone:610-565-2636
Mailing Address - Fax:
Practice Address - Street 1:36 E FRONT ST
Practice Address - Street 2:#3
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2936
Practice Address - Country:US
Practice Address - Phone:610-565-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0134101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA259832000OtherMAGELLAN BEHAVIORAL HEALT
PA44758206OtherUNITED BEHAVIORAL HEALTH
PA724562Medicaid
PA259832000OtherMAGELLAN BEHAVIORAL HEALT