Provider Demographics
NPI:1437535069
Name:CRUMB, AMBER DAWN (MA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:CRUMB
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:DAWN
Other - Last Name:RUBENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA BCBA
Mailing Address - Street 1:1350 HULL AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6431
Mailing Address - Country:US
Mailing Address - Phone:734-730-1986
Mailing Address - Fax:
Practice Address - Street 1:3313 OAKWOOD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104
Practice Address - Country:US
Practice Address - Phone:734-730-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-17-25322103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty