Healthcare Provider Details

I. General information

NPI: 1861433492
Provider Name (Legal Business Name): ROBERT R. MALAFRONTE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 PORTLAND COBALT RD
PORTLAND CT
06480-1968
US

IV. Provider business mailing address

553 PORTLAND COBALT RD
PORTLAND CT
06480-1968
US

V. Phone/Fax

Practice location:
  • Phone: 860-342-0760
  • Fax: 860-342-4226
Mailing address:
  • Phone: 860-342-0760
  • Fax: 860-342-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002719
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: