MEDICARE: KATHLEEN HELEN MALONEY MA, LPA, HSP-PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	103TC0700X	Clinical Psychologist	6545	NC

General Provider Information

NPI Number	:	1114511847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN HELEN MALONEY MA, LPA, HSP-PA

Provider Business Mailing Address
First Line	:	4397 FEDERAL DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8116
Country	:	US
Telephone Number	:	336-496-2838
Fax Number	:	336-450-4464

Provider Business Practice Location Address
First Line	:	4397 FEDERAL DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-8116
Country	:	US
Telephone Number	:	336-496-2838
Fax Number	:	336-450-4464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2021
Last Update Date	:	10/15/2024

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