Provider Demographics
NPI:1912144734
Name:ZURN, AMELIE (LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:AMELIE
Middle Name:
Last Name:ZURN
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 GIST AVE REAR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5232
Mailing Address - Country:US
Mailing Address - Phone:301-641-3401
Mailing Address - Fax:
Practice Address - Street 1:612 GIST AVE REAR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5232
Practice Address - Country:US
Practice Address - Phone:301-641-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105911041C0700X
DCLC3033901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD492002Medicare UPIN