Provider Demographics
NPI:1447061288
Name:KING, MALINDA
Entity type:Individual
Prefix:
First Name:MALINDA
Middle Name:
Last Name:KING
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 1:116 GLENWOOD RD APT 3
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2672
Mailing Address - Country:US
Mailing Address - Phone:617-816-4483
Mailing Address - Fax:
Practice Address - Street 1:450 BEDFORD ST STE 2400
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1544
Practice Address - Country:US
Practice Address - Phone:781-633-7779
Practice Address - Fax:617-458-8644
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty