Provider Demographics
NPI:1740353929
Name:MALINOFSKY, TERESA HODEL (PHD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:HODEL
Last Name:MALINOFSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:HODEL-MALINOFSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-0469
Mailing Address - Country:US
Mailing Address - Phone:413-586-3089
Mailing Address - Fax:413-727-3186
Practice Address - Street 1:19 CENTER CT
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3006
Practice Address - Country:US
Practice Address - Phone:413-586-3089
Practice Address - Fax:413-727-3186
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6488103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W05264OtherBCBS
13107OtherHNE
MA0523607Medicaid
W05264OtherBCBS