Provider Demographics
NPI:1285328625
Name:MALKUSZ-LEWIS, DANIELLE CHRISTINA (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:CHRISTINA
Last Name:MALKUSZ-LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 N WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1521
Mailing Address - Country:US
Mailing Address - Phone:917-443-5582
Mailing Address - Fax:
Practice Address - Street 1:2174 HEWLETT AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3606
Practice Address - Country:US
Practice Address - Phone:516-858-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP121539103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist