Healthcare Provider Details

I. General information

NPI: 1861940629
Provider Name (Legal Business Name): TONI MALONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23663 PARK ST
DEARBORN MI
48124-2547
US

IV. Provider business mailing address

11854 KENNEBEC ST
DETROIT MI
48205-5202
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-0030
  • Fax:
Mailing address:
  • Phone: 313-278-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001166
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: