Healthcare Provider Details

I. General information

NPI: 1336900232
Provider Name (Legal Business Name): AMY MANNER MA, CAS, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 CLARKSVILLE PIKE
ELLICOTT CITY MD
21042-6106
US

IV. Provider business mailing address

1110 BENFIELD BLVD STE J
MILLERSVILLE MD
21108-2645
US

V. Phone/Fax

Practice location:
  • Phone: 410-530-4203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: