MEDICARE: AMBER KEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	I.1901542-SUPV	OH

General Provider Information

NPI Number	:	1952752917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER KEY

Provider Business Mailing Address
First Line	:	485 BROOKWOOD DR
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-4511
Country	:	US
Telephone Number	:	937-272-2263
Fax Number	:

Provider Business Practice Location Address
First Line	:	1483 W MAIN ST
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-2803
Country	:	US
Telephone Number	:	937-937-3350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2016
Last Update Date	:	07/18/2022

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Directions to “ AMBER KEY ” Practice Location

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