Provider Demographics
NPI:1538659719
Name:CRUSE-MALONE, BRENDA ANN (LMSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:CRUSE-MALONE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MOHAWK VALLEY PSYCHIATRIC CENTER
Mailing Address - Street 2:COMMUNITY SERVICES BUILDING 1400 NOYES ST
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502
Mailing Address - Country:US
Mailing Address - Phone:315-738-4446
Mailing Address - Fax:315-738-6109
Practice Address - Street 1:MOHAWK VALLEY PSYCHIATRIC CENTER
Practice Address - Street 2:COMMUNITY SERVICES BUILDING 1400 NOYES ST
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-738-4446
Practice Address - Fax:315-738-6109
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032036-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker