Provider Demographics
NPI:1093976128
Name:MALIS, SVITLANA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SVITLANA
Middle Name:
Last Name:MALIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 CALVIN AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2461
Mailing Address - Country:US
Mailing Address - Phone:818-426-8079
Mailing Address - Fax:818-775-1174
Practice Address - Street 1:10605 BALBOA BLVD
Practice Address - Street 2:# 100
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6342
Practice Address - Country:US
Practice Address - Phone:818-832-2410
Practice Address - Fax:818-832-2409
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical