Provider Demographics
NPI:1316117203
Name:MALAVE, NATALIE (MA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MALAVE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 423183
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-3183
Mailing Address - Country:US
Mailing Address - Phone:407-968-4492
Mailing Address - Fax:
Practice Address - Street 1:7041 GRAND NATIONAL DR STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8380
Practice Address - Country:US
Practice Address - Phone:407-968-4492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3002103T00000X
FLIMH12900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist