Provider Demographics
NPI:1083129985
Name:MALINOWSKI-DIAMOND, MARYLOU (MA)
Entity Type:Individual
Prefix:
First Name:MARYLOU
Middle Name:
Last Name:MALINOWSKI-DIAMOND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 PATERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1625
Mailing Address - Country:US
Mailing Address - Phone:973-785-1476
Mailing Address - Fax:
Practice Address - Street 1:270 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1625
Practice Address - Country:US
Practice Address - Phone:973-785-1476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00033800235Z00000X
NJ41YS0003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist