Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 106S00000X | Behavior Technician |
NPI | 1083185003 |
---|---|
Provider Name | Mariam Nashwan Malakha |
First Address | Dearborn, MI 48124-2044 |
Second Address | Farmington Hills, MI 48334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2018 |
Last Update Date | 03/08/2021 |