Provider Demographics
NPI:1366476723
Name:MALITO, KIMBERLY LISA (LMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LISA
Last Name:MALITO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MARTIN LN
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6322
Mailing Address - Country:US
Mailing Address - Phone:516-639-5638
Mailing Address - Fax:
Practice Address - Street 1:15 MARTIN LN
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6322
Practice Address - Country:US
Practice Address - Phone:516-997-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072622104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker