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General NPI Number Information
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NPI Number | 1912674599
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Entity Type | Individual
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Provider Name | TAULANT MALO
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Gender | Male
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 19 TACOMA ST
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City | WORCESTER
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State | MA
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Zip | 01605-3516
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Country | US
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Telephone | 508-852-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 605 LINCOLN ST
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City | WORCESTER
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State | MA
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Zip | 01605-1901
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Country | US
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Telephone | 508-595-0750
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY10001200
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License Number State | MA
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