Provider Demographics
NPI:1649483090
Name:GORMAN, MALKA J (PSYD)
Entity type:Individual
Prefix:DR
First Name:MALKA
Middle Name:J
Last Name:GORMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MONTGOMERY ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3402
Mailing Address - Country:US
Mailing Address - Phone:415-421-4214
Mailing Address - Fax:
Practice Address - Street 1:220 MONTGOMERY ST
Practice Address - Street 2:SUITE 1800
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3402
Practice Address - Country:US
Practice Address - Phone:415-421-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17947103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist