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General NPI Number Information
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NPI Number | 1649568643
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Entity Type | Individual
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Provider Name | EVA MARIA MALIA LMHC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 05/20/2012
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Provider Practice Location Address
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Address Line | 150 CHESTNUT ST 3RD FLOOR
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City | PROVIDENCE
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State | RI
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Zip | 02903-4645
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Country | US
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Telephone | 401-680-6124
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Fax |
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Provider Business Mailing Address
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Address Line | 128 SHIRLEY BLVD
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City | CRANSTON
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State | RI
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Zip | 02910-3327
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Country | US
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Telephone | 801-541-3186
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MHC00509
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License Number State | RI
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