Provider Demographics
NPI:1467994053
Name:AMBER W. CHILDS, PH.D, LLC
Entity Type:Organization
Organization Name:AMBER W. CHILDS, PH.D, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:WIMSATT
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-785-0870
Mailing Address - Street 1:45 S MAIN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2402
Mailing Address - Country:US
Mailing Address - Phone:860-785-0870
Mailing Address - Fax:
Practice Address - Street 1:45 S MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2402
Practice Address - Country:US
Practice Address - Phone:860-785-0870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8.003495103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty