Provider Demographics
NPI:1013442367
Name:SCREEN, AMBER (MA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:SCREEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 982
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33831-0982
Mailing Address - Country:US
Mailing Address - Phone:863-934-4375
Mailing Address - Fax:
Practice Address - Street 1:211 DORIS DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1006
Practice Address - Country:US
Practice Address - Phone:863-934-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health