Healthcare Provider Details

I. General information

NPI: 1457260556
Provider Name (Legal Business Name): MALIA D DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 EVERGREEN PL STE 300
EAST ORANGE NJ
07018-2010
US

IV. Provider business mailing address

10 BLAZIER RD
WARREN NJ
07059-6909
US

V. Phone/Fax

Practice location:
  • Phone: 862-245-1106
  • Fax:
Mailing address:
  • Phone: 415-847-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: