Provider Demographics
NPI:1619287125
Name:MALCOLM, CHELSEA MARGUERITE
Entity Type:Individual
Prefix:MISS
First Name:CHELSEA
Middle Name:MARGUERITE
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3960
Mailing Address - Country:US
Mailing Address - Phone:781-828-9112
Mailing Address - Fax:508-824-0111
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3960
Practice Address - Country:US
Practice Address - Phone:781-828-9112
Practice Address - Fax:508-824-0111
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical