Healthcare Provider Details

I. General information

NPI: 1962823898
Provider Name (Legal Business Name): AMANDA MALONEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 10/13/2025
Certification Date: 01/18/2022
Deactivation Date: 01/18/2022
Reactivation Date: 10/13/2025

III. Provider practice location address

6820 AUGUSTA HILLS DR NE
RIO RANCHO NM
87144-8490
US

IV. Provider business mailing address

6820 AUGUSTA HILLS DR NE
RIO RANCHO NM
87144-8490
US

V. Phone/Fax

Practice location:
  • Phone: 913-291-5044
  • Fax:
Mailing address:
  • Phone: 913-291-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11289
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: