Provider Demographics
NPI:1982943213
Name:MALDEN, EPHPHATHA F (LCSW)
Entity Type:Individual
Prefix:
First Name:EPHPHATHA
Middle Name:F
Last Name:MALDEN
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 1:2401 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2520
Mailing Address - Country:US
Mailing Address - Phone:219-413-5100
Mailing Address - Fax:219-465-9507
Practice Address - Street 1:215 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2457
Practice Address - Country:US
Practice Address - Phone:219-921-0705
Practice Address - Fax:219-921-0557
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006605A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical