Provider Demographics
NPI:1962540740
Name:STAMBLER, ANN B (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:B
Last Name:STAMBLER
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 1:117 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2136
Mailing Address - Country:US
Mailing Address - Phone:617-527-3545
Mailing Address - Fax:617-527-2527
Practice Address - Street 1:117 LAKE AVE
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2136
Practice Address - Country:US
Practice Address - Phone:617-527-3545
Practice Address - Fax:617-527-2527
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1048971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASTP03115Medicare UPIN