Healthcare Provider Details

I. General information

NPI: 1912906801
Provider Name (Legal Business Name): MARGUERITE DEBORAH MALONE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CLEMENTS RD
COTTONDALE AL
35453-2137
US

IV. Provider business mailing address

3200 CLEMENTS RD
COTTONDALE AL
35453-2137
US

V. Phone/Fax

Practice location:
  • Phone: 205-752-7691
  • Fax:
Mailing address:
  • Phone: 205-752-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number489
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number489
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: