Provider Demographics
NPI:1396489258
Name:SIRBAUGH, AMI MICHELLE (MA, LSW)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:MICHELLE
Last Name:SIRBAUGH
Suffix:
Gender:F
Credentials:MA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 WINCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2149
Mailing Address - Country:US
Mailing Address - Phone:304-264-0225
Mailing Address - Fax:
Practice Address - Street 1:653 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2149
Practice Address - Country:US
Practice Address - Phone:304-264-0225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00944793104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker