Provider Demographics
NPI:1962068932
Name:MALINA, KEVIN JACOB (PSYD, MA, BS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JACOB
Last Name:MALINA
Suffix:
Gender:M
Credentials:PSYD, MA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39TH MEDICAL GROUP
Mailing Address - Street 2:UNIT 7095
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824-5185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39TH MEDICAL GROUP
Practice Address - Street 2:UNIT 7095
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09824-5185
Practice Address - Country:US
Practice Address - Phone:314-676-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0810007468103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program