Individual
STEPHAN IDRIS MAMBAZO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW-PIP, CGRS
Contact information
Practice address
2541 COLLEGE ST, MONTGOMERY, AL 36106-2124
(334) 207-7657
Mailing address
2541 COLLEGE ST, MONTGOMERY, AL 36106-2124
(334) 207-7657
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
SW009851L
PA
1041C0700X
Clinical Social Worker
Primary
3796C
AL
Other
Enumeration date
04/23/2015
Last updated
03/01/2017
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