Provider Demographics
NPI:1013163716
Name:MALAMUD, ELINA (LCSW)
Entity type:Individual
Prefix:
First Name:ELINA
Middle Name:
Last Name:MALAMUD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WEED AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4922
Mailing Address - Country:US
Mailing Address - Phone:917-992-1647
Mailing Address - Fax:
Practice Address - Street 1:65 WEED AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4922
Practice Address - Country:US
Practice Address - Phone:917-992-1647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076320-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03084562Medicaid
NYA400010939Medicare UPIN