Healthcare Provider Details

I. General information

NPI: 1629250808
Provider Name (Legal Business Name): LORRAINE ADELINE MALOON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LAWRENCE EXPY DEPT. 460
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

710 LAWRENCE EXPY DEPT. 460
SANTA CLARA CA
95051-5173
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-1044
  • Fax: 408-851-4559
Mailing address:
  • Phone: 408-851-1044
  • Fax: 408-851-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS12937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: