Provider Demographics
NPI:1770115602
Name:MANKER, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MANKER
Suffix:
Gender:F
Credentials:
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 4166
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-0166
Mailing Address - Country:US
Mailing Address - Phone:786-319-7627
Mailing Address - Fax:
Practice Address - Street 1:1781 NW 207TH ST APT 208
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-5059
Practice Address - Country:US
Practice Address - Phone:786-319-7627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW13347104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker