Provider Demographics
NPI:1992125736
Name:MALACHOWSKA, BEATA A
Entity type:Individual
Prefix:
First Name:BEATA
Middle Name:A
Last Name:MALACHOWSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 N MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3437
Mailing Address - Country:US
Mailing Address - Phone:917-209-3888
Mailing Address - Fax:
Practice Address - Street 1:189 N MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3437
Practice Address - Country:US
Practice Address - Phone:917-209-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-20
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002030103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst