Provider Demographics
NPI:1831324623
Name:BOGDON-ABRAMS, AMY J (LCSW-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:BOGDON-ABRAMS
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 1:701 SUDBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4761
Mailing Address - Country:US
Mailing Address - Phone:410-484-0022
Mailing Address - Fax:410-484-0022
Practice Address - Street 1:103 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4002
Practice Address - Country:US
Practice Address - Phone:410-484-0022
Practice Address - Fax:410-484-0022
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD110731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699638800Medicaid