Provider Demographics
NPI:1154598928
Name:MINTON, AMBER L (LICSW)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:L
Last Name:MINTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2912
Mailing Address - Country:US
Mailing Address - Phone:802-288-1087
Mailing Address - Fax:802-878-4404
Practice Address - Street 1:15 PINECREST DR
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-2912
Practice Address - Country:US
Practice Address - Phone:802-288-1087
Practice Address - Fax:802-878-4404
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900012321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical