MEDICARE: MS. AMBER NICOLE STANLEY LCSW

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	SW9316	FL

General Provider Information

NPI Number	:	1073899167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMBER NICOLE STANLEY LCSW

Provider Business Mailing Address
First Line	:	PO BOX 162878
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32716-2878
Country	:	US
Telephone Number	:	407-900-4212
Fax Number	:

Provider Business Practice Location Address
First Line	:	3595 W LAKE MARY BLVD
Second Line	:	SUITE C
City	:	LAKE MARY
State	:	FL
Zip	:	32746-6750
Country	:	US
Telephone Number	:	407-900-4212
Fax Number	:

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

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	08/16/2013

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