Provider Demographics
NPI:1154487338
Name:MALNATI, MICHELLE MARIE (PMHCNS,BC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARIE
Last Name:MALNATI
Suffix:
Gender:F
Credentials:PMHCNS,BC
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:LEGEYT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHCNS,BC
Mailing Address - Street 1:53 PARKER HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3225
Mailing Address - Country:US
Mailing Address - Phone:617-278-4131
Mailing Address - Fax:617-232-8399
Practice Address - Street 1:53 PARKER HILL AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120
Practice Address - Country:US
Practice Address - Phone:617-278-4131
Practice Address - Fax:617-232-8399
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258877363LP0200X, 364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics