Provider Demographics
NPI:1568739456
Name:BLANK-MALUKAS, JOAN PEARL (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:PEARL
Last Name:BLANK-MALUKAS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:JOAN
Other - Middle Name:PEARL
Other - Last Name:BLANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:14261 EDWARDS ST
Mailing Address - Street 2:APT 12
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3675
Mailing Address - Country:US
Mailing Address - Phone:714-379-0086
Mailing Address - Fax:
Practice Address - Street 1:14261 EDWARDS ST
Practice Address - Street 2:APT 12
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3675
Practice Address - Country:US
Practice Address - Phone:714-379-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 27690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist