Healthcare Provider Details

I. General information

NPI: 1063478642
Provider Name (Legal Business Name): MAUREEN MOLONEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 BELLE CHASE WAY
LANSING MI
48911
US

IV. Provider business mailing address

3475 BELLE CHASE WAY
LANSING MI
48911
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3732
  • Fax: 517-882-3633
Mailing address:
  • Phone: 517-882-3732
  • Fax: 517-882-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801019556
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: