Provider Demographics
NPI:1922307388
Name:MALESPIN, JACINTO A (MA)
Entity Type:Individual
Prefix:
First Name:JACINTO
Middle Name:A
Last Name:MALESPIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W 170TH ST
Mailing Address - Street 2:APT. 32
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2905
Mailing Address - Country:US
Mailing Address - Phone:646-281-1387
Mailing Address - Fax:
Practice Address - Street 1:709 W 170TH ST
Practice Address - Street 2:APT. 32
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2905
Practice Address - Country:US
Practice Address - Phone:646-281-1387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst