Provider Demographics
NPI:1043951676
Name:MALOUTA, CASSANDRA THERESA (MA)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:THERESA
Last Name:MALOUTA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:THERESA
Other - Last Name:SCOPETTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:108-14 72ND AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:347-392-4482
Mailing Address - Fax:347-392-4492
Practice Address - Street 1:108-14 72ND AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:347-392-4482
Practice Address - Fax:347-392-4492
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program