Provider Demographics
NPI:1881360089
Name:GANOE, AMANDA LYNN (MS, MSW, LMSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:GANOE
Suffix:
Gender:F
Credentials:MS, MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6339 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7209
Mailing Address - Country:US
Mailing Address - Phone:443-538-9909
Mailing Address - Fax:
Practice Address - Street 1:1522 LIBERTY RD STE B
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6548
Practice Address - Country:US
Practice Address - Phone:443-538-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27655104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker