Provider Demographics
NPI:1093849390
Name:MALEK, MARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:MALEK
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 1:72 VILLAGE WAY
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5109
Mailing Address - Country:US
Mailing Address - Phone:330-655-2674
Mailing Address - Fax:
Practice Address - Street 1:72 VILLAGE WAY
Practice Address - Street 2:SUITE 1A
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5109
Practice Address - Country:US
Practice Address - Phone:330-655-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5970103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMACP29371Medicare ID - Type Unspecified