Provider Demographics
NPI:1558671784
Name:MALIANI, PETER CHRISTOPHER (LAC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:CHRISTOPHER
Last Name:MALIANI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3906
Mailing Address - Country:US
Mailing Address - Phone:201-395-4813
Mailing Address - Fax:201-435-9580
Practice Address - Street 1:285 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3906
Practice Address - Country:US
Practice Address - Phone:201-395-4813
Practice Address - Fax:201-435-9580
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00064900101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor