Provider Demographics
NPI:1144237074
Name:MALIK, SAMIRA (PHD)
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:MALIK
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 1:102 WICKES ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1161
Mailing Address - Country:US
Mailing Address - Phone:210-223-6483
Mailing Address - Fax:
Practice Address - Street 1:102 WICKES ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1161
Practice Address - Country:US
Practice Address - Phone:210-223-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31941103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D0001Medicare ID - Type UnspecifiedDOCS TX
TX8D0000Medicare ID - Type UnspecifiedDOMHA TX