Provider Demographics
NPI:1346727583
Name:MALKIEWICH, JANE ELLEN (MSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELLEN
Last Name:MALKIEWICH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ELLEN
Other - Last Name:OLIVIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:241 MORELAND ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1320
Mailing Address - Country:US
Mailing Address - Phone:508-755-8596
Mailing Address - Fax:
Practice Address - Street 1:309 BELMONT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1059
Practice Address - Country:US
Practice Address - Phone:508-368-3387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1047341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical