MEDICARE: DEBORAH MALATESTA LCSW LADC LLC

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	1041C0700X	Clinical Social Worker	7137	CT

General Provider Information

NPI Number	:	1215304431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBORAH MALATESTA LCSW LADC LLC

Provider Business Mailing Address
First Line	:	14 TRUMBULL ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-6312
Country	:	US
Telephone Number	:	203-233-6036
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 TRUMBULL ST
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06511-6312
Country	:	US
Telephone Number	:	203-233-6036
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	DEBORAH MALATESTA
Credential	:	LCSW LADC
Telephone Number	:	203-233-6036

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	08/24/2015

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