Provider Demographics
NPI:1740739861
Name:AMBERMAN, ELAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:AMBERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 7TH ST N
Mailing Address - Street 2:UNIT 40
Mailing Address - City:BRADENTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34217-3304
Mailing Address - Country:US
Mailing Address - Phone:941-201-5092
Mailing Address - Fax:
Practice Address - Street 1:117 7TH ST N
Practice Address - Street 2:UNIT 40
Practice Address - City:BRADENTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:34217-3304
Practice Address - Country:US
Practice Address - Phone:941-201-5092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 112671041C0700X
NY0710691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical