Provider Demographics
NPI:1316420110
Name:MALONEY, STEPHEN VINCENT (LICSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:VINCENT
Last Name:MALONEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 INDIAN PATH RD
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:MA
Mailing Address - Zip Code:02338-1302
Mailing Address - Country:US
Mailing Address - Phone:774-226-5954
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT ST BLDG 7
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5596
Practice Address - Country:US
Practice Address - Phone:774-826-2942
Practice Address - Fax:774-826-3177
Is Sole Proprietor?:No
Enumeration Date:2018-09-08
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222060104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker