Provider Demographics
NPI:1407828049
Name:MALGIERI, LEWIS JOSHUA (PHD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:JOSHUA
Last Name:MALGIERI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S.FIRST ST STE 3
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4911
Mailing Address - Country:US
Mailing Address - Phone:315-529-3758
Mailing Address - Fax:
Practice Address - Street 1:103 PINELEDGE DR
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2017
Practice Address - Country:US
Practice Address - Phone:315-487-2951
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14813103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist