Provider Demographics
NPI:1487808465
Name:MALONEY, VINCENT THOMAS (LMFT)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:THOMAS
Last Name:MALONEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 JAMES WAY
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3284
Mailing Address - Country:US
Mailing Address - Phone:805-489-3254
Mailing Address - Fax:805-489-5948
Practice Address - Street 1:990 JAMES WAY
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3284
Practice Address - Country:US
Practice Address - Phone:805-489-3254
Practice Address - Fax:805-489-5948
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38929106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist