MEDICARE: GLENN EMERY MALONEY LICSW, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	25714	MN

General Provider Information

NPI Number	:	1386202042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN EMERY MALONEY LICSW, LADC

Provider Business Mailing Address
First Line	:	314 W SUPERIOR ST STE 314
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-1825
Country	:	US
Telephone Number	:	218-225-8498
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 W SUPERIOR ST STE 314
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-1825
Country	:	US
Telephone Number	:	218-225-8498
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	06/15/2026

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