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NPI Code Detail

MEDICARE: AMANDA CAROLINE SIEBOLD LMSW

MEDICARE: AMANDA CAROLINE SIEBOLD LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1598354193
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA CAROLINE SIEBOLD LMSW
Provider Business Mailing Address
First Line : 390 HARTMAN DR
Second Line :
City : SEVERNA PARK
State : MD
Zip : 21146-2038
Country : US
Telephone Number : 443-827-0305
Fax Number :
Provider Business Practice Location Address
First Line : 1819 BAY RIDGE AVE STE 190
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21403-2834
Country : US
Telephone Number : 443-782-5462
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2021
Last Update Date : 01/18/2021

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