Provider Demographics
NPI:1689941395
Name:SEVCIK, AMANDA MAY (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAY
Last Name:SEVCIK
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MAY
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:859 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:OH
Mailing Address - Zip Code:43758-9007
Mailing Address - Country:US
Mailing Address - Phone:740-962-6111
Mailing Address - Fax:740-962-2182
Practice Address - Street 1:859 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:OH
Practice Address - Zip Code:43758-9007
Practice Address - Country:US
Practice Address - Phone:740-962-6111
Practice Address - Fax:740-962-2182
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1100899104100000X
OHI.13035301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0247505Medicaid