Provider Demographics
NPI:1194455675
Name:AMBURGEY, RAVEN ELIZABETH (BA)
Entity type:Individual
Prefix:MS
First Name:RAVEN
Middle Name:ELIZABETH
Last Name:AMBURGEY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MERCHANT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3735
Mailing Address - Country:US
Mailing Address - Phone:283-333-9276
Mailing Address - Fax:513-348-1306
Practice Address - Street 1:135 MERCHANT ST STE 101
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3735
Practice Address - Country:US
Practice Address - Phone:283-333-9276
Practice Address - Fax:513-348-1306
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHAPP-000990696101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty