MEDICARE: REBECCA SUE MALASKY LMSW

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	104100000X	Social Worker	6801093930	MI

General Provider Information

NPI Number	:	1831738442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA SUE MALASKY LMSW

Provider Business Mailing Address
First Line	:	1988 SHERLYNN DR
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-7618
Country	:	US
Telephone Number	:	248-933-9217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1988 SHERLYNN DR
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-7618
Country	:	US
Telephone Number	:	248-933-9217
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2019
Last Update Date	:	08/16/2022

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