Individual
LESLIE EDWARD MALKIEWICH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
242 GREEN ST, GARDNER, MA 01440-1336
(978) 630-6377
Mailing address
242 GREEN ST, GARDNER, MA 01440-1336
(978) 630-6377
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2577
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
W02751
—
MA
Enumeration date
11/16/2005
Last updated
07/08/2007
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