Provider Demographics
NPI:1629263769
Name:ROBB, AMBERLEY JEAN (LMSW, CASAC)
Entity Type:Individual
Prefix:MS
First Name:AMBERLEY
Middle Name:JEAN
Last Name:ROBB
Suffix:
Gender:F
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7351 BLACK STREET RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-8951
Mailing Address - Country:US
Mailing Address - Phone:585-770-3403
Mailing Address - Fax:
Practice Address - Street 1:39 DUNCAN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569
Practice Address - Country:US
Practice Address - Phone:585-786-0190
Practice Address - Fax:585-786-0196
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0789111041C0700X
NY24563101YA0400X
NY085857-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02249145Medicaid
NY00030194303OtherUNIVERA
NY8406307OtherINDEPENDENT HEALTH
NYP014006101OtherEXCELLUS
NY000000819000OtherBLUE CROSS BLUE SHIELD OF WESTERN NEW YORK