Provider Demographics
NPI:1760147425
Name:LIVENGOOD, AMBER MARIE (LSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:LIVENGOOD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-5716
Mailing Address - Country:US
Mailing Address - Phone:717-826-7108
Mailing Address - Fax:
Practice Address - Street 1:2913 WINDMILL RD STE 1
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-1669
Practice Address - Country:US
Practice Address - Phone:484-706-9465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW134503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker