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General NPI Number Information
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NPI Number | 1598117053
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Entity Type | Organization
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Legal Business Name | KERRY L. MALAWISTA, PH.D.
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Dates
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Enumeration Date | 07/08/2016
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Last Update Date | 07/08/2016
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Provider Practice Location Address
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Address Line | 9421 THRUSH LN
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City | POTOMAC
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State | MD
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Zip | 20854-3991
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Country | US
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Telephone | 301-983-4541
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Fax |
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Provider Business Mailing Address
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Address Line | 9421 THRUSH LN
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City | POTOMAC
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State | MD
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Zip | 20854-3991
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Country | US
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Telephone | 301-983-4541
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | DR. KERRY L MALAWISTA
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Credential | PH.D.
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Telephone | 301-983-4541
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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 | 05259
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License Number State | MD
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