Provider Demographics
NPI:1063779387
Name:KUANGPARICHAT, MALYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MALYNN
Middle Name:
Last Name:KUANGPARICHAT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MALYNN
Other - Middle Name:
Other - Last Name:MIGNONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:500 ORCHARD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1812
Mailing Address - Country:US
Mailing Address - Phone:484-748-4881
Mailing Address - Fax:
Practice Address - Street 1:500 ORCHARD AVE STE C
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348
Practice Address - Country:US
Practice Address - Phone:484-748-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05484103TC0700X
PAPS017132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical