Provider Demographics
NPI:1073270369
Name:PRIVETT, AMBER LYNN (MSW, RCSWI, CWCM)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:PRIVETT
Suffix:
Gender:F
Credentials:MSW, RCSWI, CWCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 W AZEELE ST APT 254
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2940
Mailing Address - Country:US
Mailing Address - Phone:704-221-1136
Mailing Address - Fax:
Practice Address - Street 1:3510 W AZEELE ST APT 254
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2940
Practice Address - Country:US
Practice Address - Phone:704-221-1136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW15851104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLISW15851OtherRCSWI NUMBER