Provider Demographics
NPI:1255666400
Name:MYERS, MALINDA J (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:J
Last Name:MYERS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:MALINDA
Other - Middle Name:J
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1000 BENT CREEK BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-1869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 BENT CREEK BLVD STE 10
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1869
Practice Address - Country:US
Practice Address - Phone:717-988-9460
Practice Address - Fax:717-221-5422
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127316101YA0400X, 101YM0800X
PACW0167821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1E6643OtherMEDICARE
PA103221788Medicaid