MEDICARE: DR. AMBER STEVENS PSYD

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	103TC0700X	Clinical Psychologist	071009033	IL

General Provider Information

NPI Number	:	1629468228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER STEVENS PSYD

Provider Business Mailing Address
First Line	:	2245 GILBERT AVE STE 303
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-3000
Country	:	US
Telephone Number	:	513-519-0409
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 GILBERT AVE STE 303
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-3000
Country	:	US
Telephone Number	:	513-216-0068
Fax Number	:	513-216-0068

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

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	06/17/2020

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