Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1165 | KY |
Y | 103TC0700X | Clinical Psychologist | 1165 | KY |
NPI | 1003961640 |
---|---|
Provider Name | Dr. Stacy Lyn Cambron |
First Address | Louisville, KY 40222-4792 |
Second Address | Louisville, KY 40222-4792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |