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General NPI Number Information
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NPI Number | 1699850453
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Entity Type | Individual
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Provider Name | JUAN F. MALAVE L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3900 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4551
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Country | US
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Telephone | 215-924-4670
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Fax | 215-224-4105
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Provider Business Mailing Address
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Address Line | 614 DAVID ST
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City | WESTAMPTON
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State | NJ
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Zip | 08060-2402
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Country | US
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Telephone | 215-924-4670
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Fax | 215-224-4105
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SC00004900
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License Number State | NJ
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