Provider Demographics
NPI:1518027143
Name:SALAZAR, AMALIA (LCMFT)
Entity Type:Individual
Prefix:MRS
First Name:AMALIA
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LOCHNESS CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2950
Mailing Address - Country:US
Mailing Address - Phone:301-424-0844
Mailing Address - Fax:
Practice Address - Street 1:16220 FREDERICK ROAD
Practice Address - Street 2:SUITE 502
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-4022
Practice Address - Country:US
Practice Address - Phone:301-978-9750
Practice Address - Fax:301-978-9753
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCO488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD265391500Medicaid