Provider Demographics
NPI:1558452458
Name:MALOFSKY, SYDELLE (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:SYDELLE
Middle Name:
Last Name:MALOFSKY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BEECHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1125
Mailing Address - Country:US
Mailing Address - Phone:845-942-5972
Mailing Address - Fax:845-942-5972
Practice Address - Street 1:7 BEECHWOOD LN
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1125
Practice Address - Country:US
Practice Address - Phone:845-942-5972
Practice Address - Fax:845-942-5972
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO50175-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01580863Medicaid
NY1071000Medicare UPIN
NYN38111Medicare ID - Type UnspecifiedMEDICARE PROVIDER
IL027229Medicare UPIN
NY7092460Medicare UPIN
MA1071000Medicare UPIN
CA374850Medicare UPIN
NY01580863Medicaid
NYC6XG6M6JBSMedicare UPIN