Healthcare Provider Details

I. General information

NPI: 1215634134
Provider Name (Legal Business Name): MALIA HARWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25701 N LAKELAND BLVD STE 403
EUCLID OH
44132-2453
US

IV. Provider business mailing address

7531 HERMITAGE RD
CONCORD TWP OH
44077-9399
US

V. Phone/Fax

Practice location:
  • Phone: 949-500-3155
  • Fax:
Mailing address:
  • Phone: 440-231-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: