Provider Demographics
NPI:1437216918
Name:MALKIN, CRAIG E (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:E
Last Name:MALKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 RADCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-2650
Mailing Address - Country:US
Mailing Address - Phone:617-359-9850
Mailing Address - Fax:617-395-4225
Practice Address - Street 1:1218 MASSACHUSETTS AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3835
Practice Address - Country:US
Practice Address - Phone:617-491-1660
Practice Address - Fax:617-491-1661
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7886103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51066Medicare ID - Type Unspecified