Provider Demographics
NPI:1457685174
Name:MALACHOWSKI, CARRIE JENNIFER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JENNIFER
Last Name:MALACHOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:JENNIFER
Other - Last Name:CHILLEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:28980 N EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5753
Mailing Address - Country:US
Mailing Address - Phone:480-525-9962
Mailing Address - Fax:
Practice Address - Street 1:28980 N EDWARDS RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5753
Practice Address - Country:US
Practice Address - Phone:480-525-9962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127021041C0700X
AZ130271041C0700X
AZLCSW-130271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical