Provider Demographics
NPI:1487711008
Name:MALIKIAN, JOSEPH EDWARD (PH D)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:MALIKIAN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 EAST MAIN STREET
Mailing Address - Street 2:SUITE 3A2
Mailing Address - City:MT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-666-3546
Mailing Address - Fax:914-276-7674
Practice Address - Street 1:359 EAST MAIN STREET
Practice Address - Street 2:SUITE 3A2
Practice Address - City:MT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-666-3546
Practice Address - Fax:914-276-7674
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical