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General NPI Number Information
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NPI Number | 1831462936
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Entity Type | Individual
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Provider Name | AMANDA MALANGA
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Gender | Female
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 666 GODWIN AVE
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City | MIDLAND PARK
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State | NJ
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Zip | 07432-1449
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Country | US
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Telephone | 201-444-8110
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Fax |
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Provider Business Mailing Address
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Address Line | 39 WICK DR
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City | FORDS
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State | NJ
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Zip | 08863-1406
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Country | US
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Telephone | 732-770-6029
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37PC00556300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37AC00195200
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License Number State | NJ
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