Provider Demographics
NPI:1619419181
Name:ORCUTT, MALGORZATA INGA (LMFT)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:INGA
Last Name:ORCUTT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MALGORZATA
Other - Middle Name:INGA
Other - Last Name:ORCUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1211 PUERTA DEL SOL
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92690
Mailing Address - Country:US
Mailing Address - Phone:949-554-9481
Mailing Address - Fax:
Practice Address - Street 1:1211 PUERTA DEL SOL
Practice Address - Street 2:SUITE 280
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6306
Practice Address - Country:US
Practice Address - Phone:949-276-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 53599106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT 53599OtherBOARD OF BEHAVIORAL SCIENCE