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General NPI Number Information
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NPI Number | 1811385073
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Entity Type | Organization
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Legal Business Name | LORETTA S. MALTA, PH.D.
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 747 MADISON AVE SUITE 102
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City | ALBANY
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State | NY
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Zip | 12208-3809
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Country | US
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Telephone | 518-419-7716
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Fax |
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Provider Business Mailing Address
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Address Line | 76 S MANNING BLVD
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City | ALBANY
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State | NY
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Zip | 12203-1733
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Country | US
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Telephone | 518-419-7716
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | LORETTA S MALTA
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Credential | PH.D.
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Telephone | 518-419-7716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 016294
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License Number State | NY
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