Healthcare Provider Details

I. General information

NPI: 1154519528
Provider Name (Legal Business Name): CYNTHIA RENE MALEK LCSW-R, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA RENE MALEK LCSW-R, CASAC

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E GENESEE ST STE 217
SYRACUSE NY
13202-3108
US

IV. Provider business mailing address

719 HARRISON ST
SYRACUSE NY
13210-2695
US

V. Phone/Fax

Practice location:
  • Phone: 315-463-3265
  • Fax: 315-464-3282
Mailing address:
  • Phone: 315-464-3265
  • Fax: 315-464-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR082979-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: