Provider Demographics
NPI:1326879636
Name:SHANKMAN, AMANDA (LGPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SHANKMAN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3123 KESWICK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2737
Mailing Address - Country:US
Mailing Address - Phone:443-994-6714
Mailing Address - Fax:
Practice Address - Street 1:711 W 40TH ST STE 356
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2109
Practice Address - Country:US
Practice Address - Phone:410-292-1714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14337101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor