Active NPI
Leslie Edward Malkiewich, PH.D.
- Clinical Psychologist
- Gardner, MA
National Provider Identifier
1760464697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2577
- Practice address
- 242 Green St
Gardner, MA 01440-1336 - Phone
- (978) 630-6377
- NPI assigned
- Nov 16, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2577 | MA | Primary |
Addresses
Primary practice location
242 Green St
Gardner, MA 01440-1336
Mailing address
242 Green St
Gardner, MA 01440-1336
Phone (978) 630-6377
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W02751 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1760464697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "242 GREEN ST",
"city": "GARDNER",
"state": "MA",
"postal_code": "014401336",
"telephone_number": "978-630-6377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "242 GREEN ST",
"city": "GARDNER",
"state": "MA",
"postal_code": "014401336",
"telephone_number": "978-630-6377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALKIEWICH",
"first_name": "LESLIE",
"middle_name": "EDWARD",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-16",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MA",
"license": "2577",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "W02751",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gardner, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.