Healthcare Provider Details

I. General information

NPI: 1194120758
Provider Name (Legal Business Name): AMANDA DIANE CIPRIANI LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. AMANDA DIANE PICKERALL

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 05/03/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 TOWN SQUARE DR STE 3
LUSBY MD
20657-6535
US

IV. Provider business mailing address

431 EISSEL ST
NEW BERN NC
28562-2639
US

V. Phone/Fax

Practice location:
  • Phone: 410-231-0488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20699
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: