Provider Demographics
NPI:1184938094
Name:MALIECKAL, GILES PASCAL (LCSW)
Entity type:Individual
Prefix:MR
First Name:GILES
Middle Name:PASCAL
Last Name:MALIECKAL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 COLGATE AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2020
Mailing Address - Country:US
Mailing Address - Phone:516-670-2126
Mailing Address - Fax:
Practice Address - Street 1:548 THROGS NECK EXPY STE 4
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1717
Practice Address - Country:US
Practice Address - Phone:516-670-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0835931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03544492Medicaid