Provider Demographics
NPI:1083974778
Name:JASKA, AMANDA (LCPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:JASKA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 MCCORMICK RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11311 MCCORMICK RD
Practice Address - Street 2:SUITE 350
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1004
Practice Address - Country:US
Practice Address - Phone:443-849-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3807101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional