Provider Demographics
NPI:1174143820
Name:MALONE, CHRISTOPHER DANA (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DANA
Last Name:MALONE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:M 2, 1
Mailing Address - Street 2:
Mailing Address - City:MANNHEIM
Mailing Address - State:BADEN-WRTTEMBERG
Mailing Address - Zip Code:68161
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:M 2, 1
Practice Address - Street 2:
Practice Address - City:MANNHEIM
Practice Address - State:BADEN-WRTTEMBERG
Practice Address - Zip Code:68161
Practice Address - Country:DE
Practice Address - Phone:178-111-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
MA11085-PY-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11085-PY-PROtherPSYCHOLOGIST LICENSE