Provider Demographics
NPI:1982841037
Name:DESAI, MALA (MS, LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MALA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:MS, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HICKS LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-2026
Mailing Address - Country:US
Mailing Address - Phone:516-773-2894
Mailing Address - Fax:516-773-2894
Practice Address - Street 1:31 HICKS LN
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-2026
Practice Address - Country:US
Practice Address - Phone:516-773-2894
Practice Address - Fax:516-773-2894
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078446104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker