Provider Demographics
NPI:1922676139
Name:PAUL, AMANDA L (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:PAUL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20324 CEDARHURST WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-5642
Mailing Address - Country:US
Mailing Address - Phone:240-810-4964
Mailing Address - Fax:
Practice Address - Street 1:20324 CEDARHURST WAY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-5642
Practice Address - Country:US
Practice Address - Phone:240-810-4964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0229421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical