Healthcare Provider Details

I. General information

NPI: 1902938426
Provider Name (Legal Business Name): BRYCE A MALEK PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 RIVERSIDE DRIVE #305
BURBANK CA
91505
US

IV. Provider business mailing address

11333 MOORPARK STREET #149
STUDIO CITY CA
91602
US

V. Phone/Fax

Practice location:
  • Phone: 818-769-1952
  • Fax:
Mailing address:
  • Phone: 818-769-1952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 24611
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24611
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: