Corrisa Malat

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

1715 SE 32ND PL
Portland, OR 97214-5016

Phone

(503) 234-9591

NPI assigned

Sep 29, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trillium Family Services, Inc.

  • Community/Behavioral Health Agency
  • Portland, OR
  • NPI 1699059220
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697673600000",
    "number": "1790457612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 SE 32ND PL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972145016",
            "telephone_number": "503-234-9591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 SE 32ND PL",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972145016",
            "telephone_number": "503-234-9591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALAT",
        "first_name": "CORRISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-29",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Malachite Medicine LLC
• Kenneth Malam, LMT
• Ronald Gerard Malanga Jr., LCSW
• Christine M Malango, FNP
• Walter Malanowski
• Polly Kit Malby, CNM
• Jason A. Malcom
• Jenny Lara Semadeni Malcom, MD
• Marquis Malcom
• Adrian Eric Maldonado, BACHELORS

• Counselor in Portland, OR
• Providers in Portland, OR by specialty
• Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.