Healthcare Provider Details

I. General information

NPI: 1366207037
Provider Name (Legal Business Name): AMANDA MELANIE LINDSAY MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA GLASS

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16900 SCIENCE DR STE 208-210
BOWIE MD
20715-4401
US

IV. Provider business mailing address

5103 ALMOND SUNSET PL
BRANDYWINE MD
20613-4196
US

V. Phone/Fax

Practice location:
  • Phone: 240-922-0630
  • Fax: 703-841-1315
Mailing address:
  • Phone: 360-521-6053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW136037
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: