Provider Demographics
NPI:1114712122
Name:MALINOWSKI, THEODORA (PSYD)
Entity type:Individual
Prefix:DR
First Name:THEODORA
Middle Name:
Last Name:MALINOWSKI
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 VALLEY STREAM LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5852
Mailing Address - Country:US
Mailing Address - Phone:719-396-4167
Mailing Address - Fax:
Practice Address - Street 1:281 VALLEY STREAM LN
Practice Address - Street 2:
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087-5852
Practice Address - Country:US
Practice Address - Phone:719-396-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020453103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical