Healthcare Provider Details

I. General information

NPI: 1013884436
Provider Name (Legal Business Name): ONE LOVE PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25419 HUNTLEY LN
CARTHAGE NY
13619-7502
US

IV. Provider business mailing address

25419 HUNTLEY LN
CARTHAGE NY
13619-7502
US

V. Phone/Fax

Practice location:
  • Phone: 315-775-8838
  • Fax: 315-628-2063
Mailing address:
  • Phone: 315-775-8838
  • Fax: 315-628-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELINE MALCOLM
Title or Position: OWNER
Credential: LCSW
Phone: 615-424-3912