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General NPI Number Information
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NPI Number | 1134681109
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Entity Type | Individual
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Provider Name | MALAKA MIMS LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 83 MORSE ST STE 6
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City | NORWOOD
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State | MA
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Zip | 02062-4350
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Country | US
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Telephone | 508-392-5525
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Fax | 508-213-3608
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Provider Business Mailing Address
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Address Line | 55 PERRY AVE
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City | BROCKTON
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State | MA
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Zip | 02302-3606
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Country | US
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Telephone | 508-239-4475
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 122934
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License Number State | MA
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