Healthcare Provider Details

I. General information

NPI: 1689941395
Provider Name (Legal Business Name): AMANDA MAY SEVCIK MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MAY MYERS MSW, LSW

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 N MAIN ST
MALTA OH
43758-9007
US

IV. Provider business mailing address

859 N MAIN ST
MALTA OH
43758-9007
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-6111
  • Fax: 740-962-2182
Mailing address:
  • Phone: 740-962-6111
  • Fax: 740-962-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS1100899
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1303530
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: