Provider Demographics
NPI:1871264135
Name:MALONE, ANTHEA (PSYD)
Entity Type:Individual
Prefix:
First Name:ANTHEA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 69TH ST APT TH16
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5550
Mailing Address - Country:US
Mailing Address - Phone:917-513-8100
Mailing Address - Fax:
Practice Address - Street 1:333 E 69TH ST APT TH16
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5550
Practice Address - Country:US
Practice Address - Phone:917-513-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-25
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025667103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical