Provider Demographics
NPI:1457405201
Name:MAMICA, JONI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JONI
Middle Name:
Last Name:MAMICA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 4TH AVENUE EN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4160
Mailing Address - Country:US
Mailing Address - Phone:406-260-2281
Mailing Address - Fax:
Practice Address - Street 1:380 4TH AVENUE EN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4160
Practice Address - Country:US
Practice Address - Phone:406-260-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7571041C0700X
MTLCS757251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical