MEDICARE: MALINOSKI PSYCHOLOGICAL SERVICES, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	57000127A	IN

General Provider Information

NPI Number	:	1871826172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALINOSKI PSYCHOLOGICAL SERVICES, PSC

Provider Business Mailing Address
First Line	:	3560 FIVE POINTS RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-9501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3560 FIVE POINTS RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-9501
Country	:	US
Telephone Number	:	317-536-5482
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER MALINOSKI
Credential	:	PH.D.
Telephone Number	:	317-536-5482

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	09/17/2009

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