Provider Demographics
NPI:1972059079
Name:LANDFIELD, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LANDFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3079 PERRIWINKLE CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6702
Mailing Address - Country:US
Mailing Address - Phone:954-895-4711
Mailing Address - Fax:305-949-9038
Practice Address - Street 1:1926 NE 154TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-6022
Practice Address - Country:US
Practice Address - Phone:305-949-2924
Practice Address - Fax:305-949-9038
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3162101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3162OtherFCB
FL125960OtherICADC