Provider Demographics
NPI:1457657686
Name:MALAMIS, ELENI H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELENI
Middle Name:H
Last Name:MALAMIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-0143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 JORIE BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2215
Practice Address - Country:US
Practice Address - Phone:630-506-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-06
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007877103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical