Provider Demographics
NPI:1912301722
Name:WALDRON, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WALDRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 YORK RD STE 300C
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6019
Mailing Address - Country:US
Mailing Address - Phone:410-853-7691
Mailing Address - Fax:443-519-5167
Practice Address - Street 1:1205 YORK RD
Practice Address - Street 2:300 C
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6210
Practice Address - Country:US
Practice Address - Phone:410-998-3920
Practice Address - Fax:410-998-3931
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional