Provider Demographics
NPI:1366429292
Name:MALTA, LORETTA SILVANA (PHD)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:SILVANA
Last Name:MALTA
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:ALBANY VA MEDICAL CENTER
Mailing Address - Street 2:113 HOLLAND AVE, MAIL CODE 113A
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-626-5360
Mailing Address - Fax:518-626-5407
Practice Address - Street 1:ALBANY VA MEDICAL CENTER
Practice Address - Street 2:113 HOLLAND AVE, MAIL CODE 113A
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-626-5360
Practice Address - Fax:518-626-5407
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016294103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM9781Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER