Provider Demographics
NPI:1598117053
Name:KERRY L. MALAWISTA, PH.D.
Entity Type:Organization
Organization Name:KERRY L. MALAWISTA, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MALAWISTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-983-4541
Mailing Address - Street 1:9421 THRUSH LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3991
Mailing Address - Country:US
Mailing Address - Phone:301-983-4541
Mailing Address - Fax:
Practice Address - Street 1:9421 THRUSH LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3991
Practice Address - Country:US
Practice Address - Phone:301-983-4541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD052591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty