Provider Demographics
NPI:1588862940
Name:MALEK, EDGAR (MFT)
Entity type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:
Last Name:MALEK
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5429
Mailing Address - Country:US
Mailing Address - Phone:510-595-4646
Mailing Address - Fax:510-531-1054
Practice Address - Street 1:516 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5429
Practice Address - Country:US
Practice Address - Phone:510-595-4646
Practice Address - Fax:510-531-1054
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42509106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist