Basic Information
| Provider Information | |||||||||
| NPI: | 1770597007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALCY | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1380 PROGRESS WAY | ||||||||
| Address2: | #101 | ||||||||
| City: | ELDERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105495181 | ||||||||
| FaxNumber: | 4105495182 | ||||||||
| Practice Location | |||||||||
| Address1: | 1380 PROGRESS WAY | ||||||||
| Address2: | #101 | ||||||||
| City: | ELDERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105495181 | ||||||||
| FaxNumber: | 4105495182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 04029 | MD | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.