Provider Demographics
NPI:1245755115
Name:GREGORY, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:GREGORY
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 1:2828 VERNON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2414
Mailing Address - Country:US
Mailing Address - Phone:513-281-7880
Mailing Address - Fax:513-281-7884
Practice Address - Street 1:2828 VERNON PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2414
Practice Address - Country:US
Practice Address - Phone:513-281-7880
Practice Address - Fax:513-281-7884
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHD.1000862104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker