Provider Demographics
NPI:1366945396
Name:MALONEY, MOLLY ANN (MASTER OF SOCIAL WOR)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:MALONEY
Suffix:
Gender:F
Credentials:MASTER OF SOCIAL WOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 VERNON ST APT 102
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1404
Mailing Address - Country:US
Mailing Address - Phone:415-302-9699
Mailing Address - Fax:
Practice Address - Street 1:1234 EMPIRE ST STE 1500
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5711
Practice Address - Country:US
Practice Address - Phone:707-426-4746
Practice Address - Fax:707-419-4952
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health