Provider Demographics
NPI:1225510704
Name:MALIKIN, ROBERT JULES (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JULES
Last Name:MALIKIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ONEILL RD
Mailing Address - Street 2:
Mailing Address - City:HAYDENVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01039-9717
Mailing Address - Country:US
Mailing Address - Phone:413-268-0059
Mailing Address - Fax:
Practice Address - Street 1:12 ONEILL RD
Practice Address - Street 2:
Practice Address - City:HAYDENVILLE
Practice Address - State:MA
Practice Address - Zip Code:01039-9717
Practice Address - Country:US
Practice Address - Phone:413-552-4729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1004611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical