Provider Demographics
NPI:1023611845
Name:MALOOF, NICOLAS (BA)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:MALOOF
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WILKINSON DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4515
Mailing Address - Country:US
Mailing Address - Phone:978-417-6520
Mailing Address - Fax:
Practice Address - Street 1:175 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3009
Practice Address - Country:US
Practice Address - Phone:617-889-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)