Provider Demographics
NPI:1194428003
Name:MADER, AMY CLAIRE (LSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CLAIRE
Last Name:MADER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CONOVER LN
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6216
Mailing Address - Country:US
Mailing Address - Phone:732-618-5382
Mailing Address - Fax:
Practice Address - Street 1:111 CONOVER LN
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-6216
Practice Address - Country:US
Practice Address - Phone:732-618-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06812700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker