Provider Demographics
NPI:1841641776
Name:CONNELLY, AMBER LYNDSEY (BA, LSW)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LYNDSEY
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:BA, LSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNDSEY
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6837 WOODMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1142
Mailing Address - Country:US
Mailing Address - Phone:419-277-6982
Mailing Address - Fax:
Practice Address - Street 1:5115 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1801
Practice Address - Country:US
Practice Address - Phone:419-476-0784
Practice Address - Fax:419-476-0763
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1600421104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker