Provider Demographics
NPI:1306319470
Name:MALAMUD, ROBIN MARLA (LCSW)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARLA
Last Name:MALAMUD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:KREMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-0409
Mailing Address - Country:US
Mailing Address - Phone:516-314-3225
Mailing Address - Fax:
Practice Address - Street 1:900 WALT WHITMAN RD STE 304
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2215
Practice Address - Country:US
Practice Address - Phone:516-314-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0460341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty