Provider Demographics
NPI:1558138867
Name:STEVENSON, AMBER (LMSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 EVERGREEN AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2744
Mailing Address - Country:US
Mailing Address - Phone:757-202-7290
Mailing Address - Fax:
Practice Address - Street 1:315 FRONT ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3200
Practice Address - Country:US
Practice Address - Phone:757-202-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8125104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker