Healthcare Provider Details

I. General information

NPI: 1922273150
Provider Name (Legal Business Name): TIMOTHY PATRICK MALONE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 NE COURTNEY DR
BEND OR
97701-7638
US

IV. Provider business mailing address

2577 NE COURTNEY DR
BEND OR
97701-7638
US

V. Phone/Fax

Practice location:
  • Phone: 541-385-1746
  • Fax: 541-388-6617
Mailing address:
  • Phone: 541-385-1746
  • Fax: 541-388-6617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL2465
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: