Provider Demographics
NPI:1235520974
Name:MALINOSKI, KERI
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:MALINOSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 CENTRAL AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8257
Mailing Address - Country:US
Mailing Address - Phone:239-278-1140
Mailing Address - Fax:239-275-8567
Practice Address - Street 1:3615 CENTRAL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8257
Practice Address - Country:US
Practice Address - Phone:239-278-1140
Practice Address - Fax:239-275-8567
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)