Provider Demographics
NPI:1689184590
Name:MALKIEL, NORMA LUCIA (LSW, CCM)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:LUCIA
Last Name:MALKIEL
Suffix:
Gender:F
Credentials:LSW, CCM
Other - Prefix:MRS
Other - First Name:NORMA
Other - Middle Name:LUCIA
Other - Last Name:MALKIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 NEWTONVILLE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-2049
Mailing Address - Country:US
Mailing Address - Phone:617-512-7141
Mailing Address - Fax:
Practice Address - Street 1:163 GORE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1119
Practice Address - Country:US
Practice Address - Phone:617-575-5850
Practice Address - Fax:617-499-8360
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
4212629OtherCERTIFIED CASE MANAGER- CCM
MA313744OtherLICENSED SOCIAL WORKER