Provider Demographics
NPI:1841817210
Name:BENJAMIN, AMANDA (LCSW-C)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BENJAMIN
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 1:1430 HOLLINS ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2416
Mailing Address - Country:US
Mailing Address - Phone:215-266-2059
Mailing Address - Fax:
Practice Address - Street 1:1430 HOLLINS ST APT 4
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2416
Practice Address - Country:US
Practice Address - Phone:215-266-2059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD220431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical