Provider Demographics
NPI:1134216468
Name:MALCOLM, MARCELA VERONICA (MFT)
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:VERONICA
Last Name:MALCOLM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MARCELA
Other - Middle Name:
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2035 WARBLE CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6546
Mailing Address - Country:US
Mailing Address - Phone:805-262-2398
Mailing Address - Fax:
Practice Address - Street 1:2035 WARBLE CT
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6546
Practice Address - Country:US
Practice Address - Phone:805-262-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43320106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist