Provider Demographics
NPI:1477318046
Name:LISS, MALKA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MALKA
Middle Name:
Last Name:LISS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:MALKA
Other - Middle Name:
Other - Last Name:LISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:9 HEARTH CT
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-1658
Mailing Address - Country:US
Mailing Address - Phone:516-617-3417
Mailing Address - Fax:
Practice Address - Street 1:5 WHITE DOVE CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5167
Practice Address - Country:US
Practice Address - Phone:516-617-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07041900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker