Provider Demographics
NPI:1003961640
Name:CAMBRON, STACY LYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:LYN
Last Name:CAMBRON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7982 NEW LAGRANGE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4792
Mailing Address - Country:US
Mailing Address - Phone:502-426-6022
Mailing Address - Fax:502-426-9913
Practice Address - Street 1:7982 NEW LAGRANGE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4792
Practice Address - Country:US
Practice Address - Phone:502-426-6022
Practice Address - Fax:502-426-9913
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1165103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical