Provider Demographics
NPI:1902115991
Name:BORDWINE-LIEB, AMANDA GAY (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GAY
Last Name:BORDWINE-LIEB
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:GAY
Other - Last Name:BORDWINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:16 STILLWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2543
Mailing Address - Country:US
Mailing Address - Phone:410-598-2100
Mailing Address - Fax:410-265-1258
Practice Address - Street 1:16 STILLWOOD CIR
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2543
Practice Address - Country:US
Practice Address - Phone:410-598-2100
Practice Address - Fax:410-265-1258
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-25
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00010501041C0700X
MD134861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical