Provider Demographics
NPI:1477242949
Name:MALACHI LOUISON, DOLORES (LMSW)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:MALACHI LOUISON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WATER ST 2ND FLOOR
Mailing Address - Street 2:DOMESTIC VIOLENCE MENTAL HEALTH INITIATIVE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004
Mailing Address - Country:US
Mailing Address - Phone:646-532-7103
Mailing Address - Fax:
Practice Address - Street 1:234 EAST 149TH ST
Practice Address - Street 2:DV MENTAL HEALTH INITIATIVE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:646-532-7103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11866201104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker