Provider Demographics
NPI:1073899167
Name:STANLEY, AMBER NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:NICOLE
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162878
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-2878
Mailing Address - Country:US
Mailing Address - Phone:407-900-4212
Mailing Address - Fax:
Practice Address - Street 1:3595 W LAKE MARY BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6750
Practice Address - Country:US
Practice Address - Phone:407-900-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW93161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical