MEDICARE: DR. VICTOR J. MALATESTA PH.D.

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	103T00000X	Psychologist	PS004306L	PA

General Provider Information

NPI Number	:	1922219104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR J. MALATESTA PH.D.

Provider Business Mailing Address
First Line	:	515 W PLEASANT GROVE RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-7119
Country	:	US
Telephone Number	:	610-793-2794
Fax Number	:	610-642-2221

Provider Business Practice Location Address
First Line	:	515 W PLEASANT GROVE RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19382-7119
Country	:	US
Telephone Number	:	610-793-2794
Fax Number	:	610-642-2221

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

Provider Enumeration Date	:	05/27/2007
Last Update Date	:	07/08/2007

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