Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 993020 | CO |
NPI | 1003176793 |
---|---|
Provider Name | Amy E Stambuk |
First Address | Denver, CO 80238-3071 |
Second Address | Denver, CO 80230-7110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2012 |
Last Update Date | 29/05/2012 |