Provider Demographics
NPI:1992159024
Name:MALUCHNIK, AMANDA ELISABETH-JANE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ELISABETH-JANE
Last Name:MALUCHNIK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:E-J
Other - Last Name:LYTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:960 ALPINE CHURCH RD NW APT C
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-7303
Mailing Address - Country:US
Mailing Address - Phone:616-401-8267
Mailing Address - Fax:
Practice Address - Street 1:375 APPLE TREE DR
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-7506
Practice Address - Country:US
Practice Address - Phone:616-902-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011143561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical