Provider Demographics
NPI:1679505390
Name:KINCAID, AMBERLY EDGLEY (BCD, LISW, QMPH)
Entity type:Individual
Prefix:
First Name:AMBERLY
Middle Name:EDGLEY
Last Name:KINCAID
Suffix:
Gender:
Credentials:BCD, LISW, QMPH
Other - Prefix:
Other - First Name:AMBERLY
Other - Middle Name:EDGLEY
Other - Last Name:STEPEHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:511 N FORT THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1505
Mailing Address - Country:US
Mailing Address - Phone:859-653-0588
Mailing Address - Fax:
Practice Address - Street 1:511 N FORT THOMAS AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1505
Practice Address - Country:US
Practice Address - Phone:859-653-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
604861041C0700X
KY32841041C0700X
OHI.12014751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY184607OtherMEDICARE GROUP NUMBER