Provider Demographics
NPI:1073760609
Name:MALKUS, BETTY MUMFORD (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:MUMFORD
Last Name:MALKUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 EGYPT RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-3701
Mailing Address - Country:US
Mailing Address - Phone:410-463-3306
Mailing Address - Fax:410-221-5093
Practice Address - Street 1:411 MUSE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1822
Practice Address - Country:US
Practice Address - Phone:410-463-3306
Practice Address - Fax:410-221-5093
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3101103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist