Healthcare Provider Details

I. General information

NPI: 1053371278
Provider Name (Legal Business Name): KAREN DIANN MALINA CSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 BUSHNELL RD
CHATHAM NY
12037-3909
US

IV. Provider business mailing address

338 BUSHNELL RD
CHATHAM NY
12037-3909
US

V. Phone/Fax

Practice location:
  • Phone: 518-392-6176
  • Fax:
Mailing address:
  • Phone: 518-392-6176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR 020257-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: