Provider Demographics
NPI:1609584812
Name:MALMSTROM, EMILY KAY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KAY
Last Name:MALMSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2337
Mailing Address - Country:US
Mailing Address - Phone:216-859-9500
Mailing Address - Fax:216-415-5635
Practice Address - Street 1:2020 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2337
Practice Address - Country:US
Practice Address - Phone:216-859-9500
Practice Address - Fax:216-415-5635
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH182496101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty