Individual
SUSAN E.L. MALCOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1321 WASHINGTON AVE STE 312, PORTLAND, ME 04103-3675
(207) 423-5546
Mailing address
1321 WASHINGTON AVE STE 312, PORTLAND, ME 04103-3675
(207) 423-5546
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC7270
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
298650099
—
ME
Enumeration date
08/31/2006
Last updated
08/21/2019
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