MEDICARE: AMBER J MICHAEL LSW

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	104100000X	Social Worker	S.2005695	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.130161	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	S.2005695	OTHER	OH	COUNSELOR, SOCIAL WORKER, & MFT BOARD

General Provider Information

NPI Number	:	1063053668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER J MICHAEL LSW

Provider Business Mailing Address
First Line	:	4998 W BROAD ST STE 104
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1647
Country	:	US
Telephone Number	:	614-754-8051
Fax Number	:	614-319-6123

Provider Business Practice Location Address
First Line	:	4998 W BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1647
Country	:	US
Telephone Number	:	614-754-8051
Fax Number	:	614-319-6123

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

Provider Enumeration Date	:	10/04/2019
Last Update Date	:	02/18/2026

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Directions to “ AMBER J MICHAEL LSW” Practice Location

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