Provider Demographics
NPI:1801307178
Name:MALONE, TIMISHA (LICSW)
Entity type:Individual
Prefix:
First Name:TIMISHA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:TIMISHA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:237 HEDDING RD
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-1525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:237 HEDDING RD
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042-1525
Practice Address - Country:US
Practice Address - Phone:603-815-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical