Provider Demographics
NPI:1083788871
Name:EASLEY, AMY LYNN (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:EASLEY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9418
Mailing Address - Country:US
Mailing Address - Phone:410-971-1371
Mailing Address - Fax:
Practice Address - Street 1:507 W CHESAPEAKE AVE
Practice Address - Street 2:SUITE 509
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4345
Practice Address - Country:US
Practice Address - Phone:443-519-5752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD094651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405288900Medicaid
MD808601000Medicaid
MD808601000Medicaid