Provider Demographics
NPI:1033340591
Name:MALONE, DENISE BARTIZAL (PSYD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:BARTIZAL
Last Name:MALONE
Suffix:
Gender:F
Credentials:PSYD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19423 INDIAN RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-8819
Mailing Address - Country:US
Mailing Address - Phone:540-761-6306
Mailing Address - Fax:
Practice Address - Street 1:19423 INDIAN RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-8819
Practice Address - Country:US
Practice Address - Phone:540-761-6306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-01
Last Update Date:2009-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11000078103K00000X
VA0810000359103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist