Provider Demographics
NPI:1265441182
Name:AYRAULT, AMY ELIZABETH (LCSW-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:AYRAULT
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 1:8310 KENDALE RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5014
Mailing Address - Country:US
Mailing Address - Phone:585-738-1344
Mailing Address - Fax:
Practice Address - Street 1:7702 DUNMANWAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-5436
Practice Address - Country:US
Practice Address - Phone:410-282-1792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD140011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical