Provider Demographics
NPI:1245315670
Name:MALKIN, MARILYN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:MALKIN
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 1:2460 FAIRMOUNT BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3164
Mailing Address - Country:US
Mailing Address - Phone:440-779-6773
Mailing Address - Fax:216-231-7235
Practice Address - Street 1:2460 FAIRMOUNT BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3164
Practice Address - Country:US
Practice Address - Phone:440-779-6773
Practice Address - Fax:216-231-7235
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3385103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH81364OtherQUALCHOICE
OH000000146423OtherANTHEM
OH000000146423OtherANTHEM