Provider Demographics
NPI:1407313299
Name:STICKLES, AMBER R
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:R
Last Name:STICKLES
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 1:64 BEACON ST APT C109
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2284
Mailing Address - Country:US
Mailing Address - Phone:508-431-8366
Mailing Address - Fax:
Practice Address - Street 1:64 BEACON ST APT C109
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2284
Practice Address - Country:US
Practice Address - Phone:508-431-8366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst