Provider Demographics
NPI:1629569769
Name:DAVIDSON, AMBER LYNN
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LYNN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23701 MILES RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5473
Mailing Address - Country:US
Mailing Address - Phone:216-763-0800
Mailing Address - Fax:216-763-0810
Practice Address - Street 1:23701 MILES RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128
Practice Address - Country:US
Practice Address - Phone:216-763-0800
Practice Address - Fax:216-763-0810
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0321298Medicaid