Provider Demographics
NPI:1134543127
Name:MALTBY, GEORGINA E (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGINA
Middle Name:E
Last Name:MALTBY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HANOVER LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7224
Mailing Address - Country:US
Mailing Address - Phone:530-828-3446
Mailing Address - Fax:
Practice Address - Street 1:48 HANOVER LN
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7224
Practice Address - Country:US
Practice Address - Phone:530-828-3446
Practice Address - Fax:530-592-3867
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25860103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist