Provider Demographics
NPI:1669528469
Name:MALIS, DENISE ANNE (LMHC)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ANNE
Last Name:MALIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 EUSTIS ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2205
Mailing Address - Country:US
Mailing Address - Phone:617-868-5085
Mailing Address - Fax:617-628-2595
Practice Address - Street 1:139 LARCH RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3316
Practice Address - Country:US
Practice Address - Phone:617-497-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0978OtherBLUE CROSS BLUE SHIELD