Provider Demographics
NPI:1225716756
Name:ELAWAMRY, MALAK M (MA)
Entity Type:Individual
Prefix:
First Name:MALAK
Middle Name:M
Last Name:ELAWAMRY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 E COLORADO BLVD STE 433
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2057
Mailing Address - Country:US
Mailing Address - Phone:626-206-3139
Mailing Address - Fax:
Practice Address - Street 1:595 E COLORADO BLVD STE 433
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2057
Practice Address - Country:US
Practice Address - Phone:626-206-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13878101YP2500X
CA139651106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional