MEDICARE: MS. RACHELLE K MALONE LCSW C

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	104100000X	Social Worker	12009	MD

General Provider Information

NPI Number	:	1225148141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHELLE K MALONE LCSW C

Provider Business Mailing Address
First Line	:	6425 4TH AVE
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-4708
Country	:	US
Telephone Number	:	240-751-0381
Fax Number	:	240-582-6841

Provider Business Practice Location Address
First Line	:	7676 NEW HAMPSHIRE AVE
Second Line	:	SUITE 220
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-7512
Country	:	US
Telephone Number	:	240-485-1786
Fax Number	:	301-439-0008

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/20/2007

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