Provider Demographics
NPI:1225567985
Name:CIRINO, MALTA ANGELICA (CASAC)
Entity Type:Individual
Prefix:MS
First Name:MALTA
Middle Name:ANGELICA
Last Name:CIRINO
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 PARK AVE APT 12A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3536
Mailing Address - Country:US
Mailing Address - Phone:646-271-5043
Mailing Address - Fax:
Practice Address - Street 1:1751 PARK AVENUE
Practice Address - Street 2:BAILEY HOUSE OASAS CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:212-991-4994
Practice Address - Fax:212-414-1431
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7166101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)