Provider Demographics
NPI:1376253146
Name:MALONE, MONICA MIA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MIA
Last Name:MALONE
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 1:648 PARK PL APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-8829
Mailing Address - Country:US
Mailing Address - Phone:210-273-2227
Mailing Address - Fax:
Practice Address - Street 1:65 BROADWAY STE 505
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2540
Practice Address - Country:US
Practice Address - Phone:212-677-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling