Provider Demographics
NPI:1811190671
Name:WEINTRAUB, MALKA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:MALKA
Middle Name:
Last Name:WEINTRAUB
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6317 WALLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3122
Mailing Address - Country:US
Mailing Address - Phone:410-358-0777
Mailing Address - Fax:410-318-8310
Practice Address - Street 1:6317 WALLIS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3122
Practice Address - Country:US
Practice Address - Phone:410-358-0777
Practice Address - Fax:410-318-8310
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional