Provider Demographics
NPI:1679050561
Name:MALKIN, ALISON LISA (LICSW)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:LISA
Last Name:MALKIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1315
Mailing Address - Country:US
Mailing Address - Phone:781-275-1962
Mailing Address - Fax:
Practice Address - Street 1:457 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-2224
Practice Address - Country:US
Practice Address - Phone:617-559-6237
Practice Address - Fax:617-559-6204
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10188391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical