Mary L Malik, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY19861 Issued in CA

Practice address

1110 California Blvd Ste a
San Luis Obispo, CA 93401-2970

Phone

(805) 541-2490

NPI assigned

Aug 2, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566000000000",
    "number": "1053328823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 CALIFORNIA BLVD STE A",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012970",
            "telephone_number": "805-541-2490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 CALIFORNIA BLVD STE A",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012970",
            "telephone_number": "805-541-2490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALIK",
        "first_name": "MARY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-02",
        "last_updated": "2019-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY19861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA PIN",
            "identifier": "OPL198610",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristin M Makena, LICENSED EDUC. PSYCH
• Diana Marie Makowetski
• Zoe Ray Makowetski
• Eva Malama, CMT
• Henry Abdel Malek, M.D.
• Jessica M Malone, NP
• Timothy Malone, LMFT
• Michael J Malotte
• Jeremiah Malzhan
• Zachariah Malzhan, C.P.,C.O.A.

• Psychologist in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.