Provider Demographics
NPI:1801075692
Name:AMOSS, GEORGE EDWARD JR (LGSW)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWARD
Last Name:AMOSS
Suffix:JR
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1213
Mailing Address - Country:US
Mailing Address - Phone:410-496-2410
Mailing Address - Fax:410-496-2411
Practice Address - Street 1:219 MAIN ST
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1213
Practice Address - Country:US
Practice Address - Phone:410-496-2410
Practice Address - Fax:410-496-2411
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG12084104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG12084OtherLGSW