Provider Demographics
NPI:1699293563
Name:MALONE, GEOFFREY K (LCSW)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:K
Last Name:MALONE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1789
Mailing Address - Country:US
Mailing Address - Phone:516-289-5666
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:4131 W LOOMIS RD STE 120
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2057
Practice Address - Country:US
Practice Address - Phone:414-424-2445
Practice Address - Fax:414-424-2446
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical