Provider Demographics
NPI:1720836380
Name:NEWSWANGER, AMANDA (MED)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:NEWSWANGER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 MILLER CIR
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-1217
Mailing Address - Country:US
Mailing Address - Phone:717-395-5705
Mailing Address - Fax:
Practice Address - Street 1:1021 MILLER CIR
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-1217
Practice Address - Country:US
Practice Address - Phone:717-395-5705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional