Provider Demographics
NPI:1619601465
Name:MALATY, JEAN-PHILIPPE
Entity Type:Individual
Prefix:
First Name:JEAN-PHILIPPE
Middle Name:
Last Name:MALATY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ARTIST RD # 58
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2079
Mailing Address - Country:US
Mailing Address - Phone:970-379-9838
Mailing Address - Fax:
Practice Address - Street 1:320 ARTIST RD # 58
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2079
Practice Address - Country:US
Practice Address - Phone:970-379-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician