Healthcare Provider Details

I. General information

NPI: 1174143820
Provider Name (Legal Business Name): CHRISTOPHER DANA MALONE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 07/21/2022
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

M 2, 1
MANNHEIM BADEN-WRTTEMBERG
68161
DE

IV. Provider business mailing address

M 2, 1
MANNHEIM BADEN-WRTTEMBERG
68161
DE

V. Phone/Fax

Practice location:
  • Phone: 178-111-0464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11085-PY-PR
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: