Provider Demographics
NPI:1912318734
Name:LEAL, AMANDA MARIE (LCSW-C)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MARIE
Last Name:LEAL
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 1:6050 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ST LEONARD
Mailing Address - State:MD
Mailing Address - Zip Code:20685
Mailing Address - Country:US
Mailing Address - Phone:443-624-6285
Mailing Address - Fax:
Practice Address - Street 1:22655 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-3848
Practice Address - Country:US
Practice Address - Phone:301-690-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076871041C0700X
MD197931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589561802Medicaid