Provider Demographics
NPI:1669725255
Name:MORGAN, AMANDA R (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:R
Last Name:MORGAN
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:PO BOX 22684
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21203-4684
Mailing Address - Country:US
Mailing Address - Phone:443-863-9191
Mailing Address - Fax:
Practice Address - Street 1:305 W MONUMENT ST
Practice Address - Street 2:#305
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4619
Practice Address - Country:US
Practice Address - Phone:443-863-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD182191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical