Provider Demographics
NPI:1861741852
Name:MALAWY, RACHAEL VICTORIA (BCBA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:VICTORIA
Last Name:MALAWY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3046
Mailing Address - Country:US
Mailing Address - Phone:618-201-7863
Mailing Address - Fax:
Practice Address - Street 1:2315 N PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3046
Practice Address - Country:US
Practice Address - Phone:618-201-7863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst