Provider Demographics
NPI:1770791048
Name:MALMUD, ELSA KRAVITZ (PHD)
Entity type:Individual
Prefix:DR
First Name:ELSA
Middle Name:KRAVITZ
Last Name:MALMUD
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 1:971 FRAZIER RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2407
Mailing Address - Country:US
Mailing Address - Phone:215-885-0756
Mailing Address - Fax:
Practice Address - Street 1:971 FRAZIER RD
Practice Address - Street 2:
Practice Address - City:RYDAL
Practice Address - State:PA
Practice Address - Zip Code:19046-2407
Practice Address - Country:US
Practice Address - Phone:215-885-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-002996-L103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent