Provider Demographics
NPI:1326377706
Name:NICHOLAS MALVEY, KATHERINE E (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:E
Last Name:NICHOLAS MALVEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1901
Mailing Address - Country:US
Mailing Address - Phone:508-856-0104
Mailing Address - Fax:508-856-7425
Practice Address - Street 1:605 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1901
Practice Address - Country:US
Practice Address - Phone:508-856-0104
Practice Address - Fax:508-856-7425
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216109104100000X
MA1165621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical