MEDICARE: MS. CHANDRA ELISE MALAMUD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW13583	FL

General Provider Information

NPI Number	:	1841865128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHANDRA ELISE MALAMUD LCSW

Provider Business Mailing Address
First Line	:	4027 OAK FOREST DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-5782
Country	:	US
Telephone Number	:	850-387-3097
Fax Number	:

Provider Business Practice Location Address
First Line	:	4027 OAK FOREST DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-5782
Country	:	US
Telephone Number	:	850-387-3097
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	05/20/2021

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