Provider Demographics
NPI:1922219104
Name:MALATESTA, VICTOR J (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:J
Last Name:MALATESTA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7119
Mailing Address - Country:US
Mailing Address - Phone:610-793-2794
Mailing Address - Fax:610-642-2221
Practice Address - Street 1:515 W PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-7119
Practice Address - Country:US
Practice Address - Phone:610-793-2794
Practice Address - Fax:610-642-2221
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004306L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA129489Medicare ID - Type UnspecifiedMEDICARE