Provider Demographics
NPI:1225137979
Name:AMBERS, SCOTT JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JOHN
Last Name:AMBERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 W WOLFRAM ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5107
Mailing Address - Country:US
Mailing Address - Phone:773-929-3389
Mailing Address - Fax:773-296-1169
Practice Address - Street 1:233 E ERIE ST
Practice Address - Street 2:SUITE 601
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2926
Practice Address - Country:US
Practice Address - Phone:312-409-4147
Practice Address - Fax:773-296-1169
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7364492OtherAETNA
IL21623066OtherBLUE CROSS & BLUE SHIELD
IL204189Medicare ID - Type Unspecified