Provider Demographics
NPI:1407564073
Name:ISRAEL, MALKA O
Entity Type:Individual
Prefix:
First Name:MALKA
Middle Name:O
Last Name:ISRAEL
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 1:725 N HIGHWAY A1A STE A104
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4561
Mailing Address - Country:US
Mailing Address - Phone:561-446-0446
Mailing Address - Fax:
Practice Address - Street 1:918 33RD ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-4708
Practice Address - Country:US
Practice Address - Phone:156-150-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool