Provider Demographics
NPI:1053371278
Name:MALINA, KAREN DIANN (CSW-R)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:DIANN
Last Name:MALINA
Suffix:
Gender:F
Credentials:CSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 BUSHNELL RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12037-3909
Mailing Address - Country:US
Mailing Address - Phone:518-392-6176
Mailing Address - Fax:
Practice Address - Street 1:338 BUSHNELL RD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037-3909
Practice Address - Country:US
Practice Address - Phone:518-392-6176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR 020257-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7334049OtherGHI PROVIDER ID NUMBER