Provider Demographics
NPI:1548729395
Name:MALONE, AMANDA MARIE (MSW LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:MALONE
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:MALONE-DIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:10350 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5114
Mailing Address - Country:US
Mailing Address - Phone:443-286-7819
Mailing Address - Fax:
Practice Address - Street 1:4738 COUNTY ROAD 5
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-8913
Practice Address - Country:US
Practice Address - Phone:720-295-2596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
COCSW.099259451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker