Provider Demographics
NPI:1093047045
Name:ALCHEMY OF AGING, LESLIE K MALIN, LCSW PC
Entity type:Organization
Organization Name:ALCHEMY OF AGING, LESLIE K MALIN, LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:MALIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:845-706-3114
Mailing Address - Street 1:17 VALLEY STREET
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-1829
Mailing Address - Country:US
Mailing Address - Phone:845-706-3114
Mailing Address - Fax:
Practice Address - Street 1:17 VALLEY ST
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-1829
Practice Address - Country:US
Practice Address - Phone:845-706-3114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021282-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty