Healthcare Provider Details

I. General information

NPI: 1992249593
Provider Name (Legal Business Name): MR. STEPHEN KWAME AMABLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 COOPER ST APT 35
BEVERLY NJ
08010-3007
US

IV. Provider business mailing address

1306 COOPER ST APT 35
BEVERLY NJ
08010-3007
US

V. Phone/Fax

Practice location:
  • Phone: 240-755-3055
  • Fax: 609-479-9986
Mailing address:
  • Phone: 240-755-3055
  • Fax: 609-479-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: