Healthcare Provider Details

I. General information

NPI: 1396341244
Provider Name (Legal Business Name): AMY HULL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N BOND ST
BEL AIR MD
21014-3556
US

IV. Provider business mailing address

994 TELEGRAPH RD
RISING SUN MD
21911-1908
US

V. Phone/Fax

Practice location:
  • Phone: 410-937-7547
  • Fax:
Mailing address:
  • Phone: 443-907-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26492
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number26492
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: