Provider Demographics
NPI:1104428820
Name:ROMERO, AMBER ANN (MSP)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ANN
Last Name:ROMERO
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:ANN
Other - Last Name:POTTHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14401 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4262
Mailing Address - Country:US
Mailing Address - Phone:602-918-9797
Mailing Address - Fax:
Practice Address - Street 1:14050 N 83RD AVE STE 290
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5650
Practice Address - Country:US
Practice Address - Phone:602-529-6102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health