Healthcare Provider Details

I. General information

NPI: 1376969642
Provider Name (Legal Business Name): MATTHEW ADIB MALOUF PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HAMILL RD STE 120
BALTIMORE MD
21210-1847
US

IV. Provider business mailing address

2 HAMILL RD STE 120
BALTIMORE MD
21210-1847
US

V. Phone/Fax

Practice location:
  • Phone: 443-582-3955
  • Fax:
Mailing address:
  • Phone: 443-582-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number05610
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number003348
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: