MEDICARE: AMBER MICHELLE ANZALONE 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	8763	TN

General Provider Information

NPI Number	:	1710482849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MICHELLE ANZALONE LCSW

Provider Business Mailing Address
First Line	:	1907 N ROAN ST STE 205
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-3182
Country	:	US
Telephone Number	:	423-427-6272
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 N ROAN ST STE 205
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-3182
Country	:	US
Telephone Number	:	423-427-6272
Fax Number	:

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

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	05/10/2024

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