MEDICARE: AMANDA PODBIELSKI LCSW-C

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
1	1041C0700X	Clinical Social Worker	20207	MD

General Provider Information

NPI Number	:	1689130361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA PODBIELSKI LCSW-C

Provider Business Mailing Address
First Line	:	1405 POINT ST APT 1516
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21231-3691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2914 E JOPPA RD STE 100
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21234-3045
Country	:	US
Telephone Number	:	443-676-1099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2019
Last Update Date	:	02/18/2019

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