Provider Demographics
NPI:1679092746
Name:GERRICK, AMANDA ELIZABETH
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:GERRICK
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 1:2644 CAPITOL TRL STE 250
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7231
Mailing Address - Country:US
Mailing Address - Phone:302-683-1055
Mailing Address - Fax:
Practice Address - Street 1:2644 CAPITOL TRL STE 250
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7231
Practice Address - Country:US
Practice Address - Phone:302-683-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
DEAC-0000306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD483106300Medicaid