Provider Demographics
NPI:1912254103
Name:MALAY, MARK P (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:MALAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2604 EL CAMINO REAL STE B
Mailing Address - Street 2:#291
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1205
Mailing Address - Country:US
Mailing Address - Phone:760-644-2482
Mailing Address - Fax:
Practice Address - Street 1:2103 S EL CAMINO REAL
Practice Address - Street 2:#207
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6248
Practice Address - Country:US
Practice Address - Phone:760-644-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35611106H00000X
CAPSY26870103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist