Provider Demographics
NPI:1275655367
Name:MALVAROSA, GINA M (LMHC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:MALVAROSA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151
Mailing Address - Country:US
Mailing Address - Phone:617-584-2128
Mailing Address - Fax:781-629-1755
Practice Address - Street 1:89 NEWBURY ST STE 101
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1098
Practice Address - Country:US
Practice Address - Phone:617-584-2128
Practice Address - Fax:781-629-1755
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health