Provider Demographics
NPI:1083924922
Name:SURGES MARTORELLA, AMANI M (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:AMANI
Middle Name:M
Last Name:SURGES MARTORELLA
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:AMANI
Other - Middle Name:M
Other - Last Name:SURGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1235 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1902
Mailing Address - Country:US
Mailing Address - Phone:410-800-2414
Mailing Address - Fax:
Practice Address - Street 1:8830 ORCHARD TREE LN
Practice Address - Street 2:STE 127
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21286-2143
Practice Address - Country:US
Practice Address - Phone:443-632-6306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD153281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical