Provider Demographics
NPI:1568181485
Name:MENZEL, AMANDA RENEE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RENEE
Last Name:MENZEL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:RENEE
Other - Last Name:LARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:9714 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1154
Practice Address - Country:US
Practice Address - Phone:410-641-3340
Practice Address - Fax:410-641-3341
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD235351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid