Provider Demographics
NPI:1417358250
Name:STANLEY, AMBER (LISW-S)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 SAGE RUN DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-3918
Mailing Address - Country:US
Mailing Address - Phone:937-263-0060
Mailing Address - Fax:
Practice Address - Street 1:4104 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-6118
Practice Address - Country:US
Practice Address - Phone:937-263-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.11002161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical