Provider Demographics
NPI:1568818573
Name:MALMGREN, FLORENCE (MFT)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:MALMGREN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11858 BERNARDO PLAZA CT
Mailing Address - Street 2:#210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2439
Mailing Address - Country:US
Mailing Address - Phone:858-524-4300
Mailing Address - Fax:
Practice Address - Street 1:11858 BERNARDO PLAZA CT
Practice Address - Street 2:210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2439
Practice Address - Country:US
Practice Address - Phone:858-524-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38274106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist