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General NPI Number Information
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NPI Number | 1568353654
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Entity Type | Organization
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Legal Business Name | MALACHITE INSTITUTE FOR BEHAVIORAL HEALTH, INC
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 609 SOUTH BLVD APT A
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City | OAK PARK
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State | IL
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Zip | 60302-2937
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Country | US
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Telephone | 240-802-2983
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Fax |
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Provider Business Mailing Address
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Address Line | 609 SOUTH BLVD APT A
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City | OAK PARK
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State | IL
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Zip | 60302-2937
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Country | US
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Telephone | 773-865-9286
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | LAYLA KASSEM
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Credential | PSYD PHD
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Telephone | 773-865-9286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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