Provider Demographics
NPI:1376969642
Name:MALOUF, MATTHEW ADIB (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ADIB
Last Name:MALOUF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 ROLAND AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2347
Mailing Address - Country:US
Mailing Address - Phone:443-885-0889
Mailing Address - Fax:
Practice Address - Street 1:4800 ROLAND AVE STE 301
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2347
Practice Address - Country:US
Practice Address - Phone:443-885-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003348103T00000X
MD05610103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist