Provider Demographics
NPI:1831906320
Name:HARTWIG, AMANDA
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:HARTWIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23160 MOAKLEY ST
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2922
Mailing Address - Country:US
Mailing Address - Phone:240-673-6367
Mailing Address - Fax:
Practice Address - Street 1:46060 MILLSTONE LANDING RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-2149
Practice Address - Country:US
Practice Address - Phone:301-863-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCER-110325-V0C6V2103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool