Provider Demographics
NPI:1679977912
Name:ELERY, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:ELERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 LEE RD APT A213
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2243
Mailing Address - Country:US
Mailing Address - Phone:321-460-6597
Mailing Address - Fax:
Practice Address - Street 1:1695 LEE RD APT A213
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2243
Practice Address - Country:US
Practice Address - Phone:321-460-6597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker