Healthcare Provider Details

I. General information

NPI: 1154002012
Provider Name (Legal Business Name): CASSANDRA MIRIAM MALACK MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WINDRIM AVE
PHILADELPHIA PA
19141-2710
US

IV. Provider business mailing address

115 GLADSTONE RD
LANSDOWNE PA
19050-2110
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-2737
  • Fax:
Mailing address:
  • Phone: 484-334-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: