Provider Demographics
NPI:1528780939
Name:DR. GENEVIEVE MALTBY LLC
Entity type:Organization
Organization Name:DR. GENEVIEVE MALTBY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALTBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-962-5585
Mailing Address - Street 1:861 N MADISON ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3058
Mailing Address - Country:US
Mailing Address - Phone:815-871-2410
Mailing Address - Fax:
Practice Address - Street 1:861 N MADISON ST STE 5
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3058
Practice Address - Country:US
Practice Address - Phone:815-871-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty