Provider Demographics
NPI:1972039394
Name:MALKIEWICZ, JOSEPH REED
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:REED
Last Name:MALKIEWICZ
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 1:630 MASSELIN AVE APT 224
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5760
Mailing Address - Country:US
Mailing Address - Phone:615-429-7936
Mailing Address - Fax:
Practice Address - Street 1:630 MASSELIN AVE APT 224
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5760
Practice Address - Country:US
Practice Address - Phone:615-429-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist