Provider Demographics
NPI:1750033478
Name:STACY L CAMBRON PHD
Entity Type:Organization
Organization Name:STACY L CAMBRON PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:CAMBRON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-426-6022
Mailing Address - Street 1:7982 NEW LA GRANGE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4792
Mailing Address - Country:US
Mailing Address - Phone:502-426-6022
Mailing Address - Fax:
Practice Address - Street 1:7982 NEW LA GRANGE RD STE 4
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4792
Practice Address - Country:US
Practice Address - Phone:502-426-6022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STACY L CAMBRON PHD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)