Provider Demographics
NPI:1760026413
Name:PEZZANITE, AMANDA JOYCE JACOB (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOYCE JACOB
Last Name:PEZZANITE
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 1:4915 SAINT ELMO AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6019
Mailing Address - Country:US
Mailing Address - Phone:301-299-0063
Mailing Address - Fax:
Practice Address - Street 1:4915 SAINT ELMO AVE STE 504
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6019
Practice Address - Country:US
Practice Address - Phone:301-299-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD191511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical