Provider Demographics
NPI:1831347558
Name:JOSEPH, MALCOLM
Entity type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 BUNKER HILL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1712
Mailing Address - Country:US
Mailing Address - Phone:617-312-3166
Mailing Address - Fax:
Practice Address - Street 1:389 BUNKER HILL ST APT 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02129-1712
Practice Address - Country:US
Practice Address - Phone:617-444-7348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15959225171M00000X
MA1186041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator