Individual
MALCOLM ROSE SUSHCHYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW 00012367
Contact information
Practice address
380 BROADWAY, PROVIDENCE, RI 02909-1416
(650) 516-6672
Mailing address
380 BROADWAY, PROVIDENCE, RI 02909-1416
(650) 516-6672
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
123679
MA
1041C0700X
Clinical Social Worker
99467
CA
1041C0700X
Clinical Social Worker
Primary
ISW03525
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
99467
BOARD OF BEHAVIORAL SCIENCES
CA
Enumeration date
07/10/2014
Last updated
10/28/2025
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