Individual provider · Type 1 NPI
Stephan Idris Mambazo, MSW, LICSW-PIP, CGRS
Clinical Social Worker · Montgomery, AL
Practice location
201 Taylor Oaks Cir Unit 104
Montgomery, AL 36116-8538
Fax (855) 461-3448
Mailing address
PO Box 230155
Montgomery, AL 36123-0155
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinical Social Worker | 1041C0700X | 3796C (AL) |
| Social Worker | 104100000X | SW009851L (PA) |
| Clinical Social Worker | 1041C0700X | TPSW1856 (FL) |
| Clinical Social Worker Primary | 1041C0700X | Q1-0013037 (DE) |
Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…
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About NPI 1609263052
Stephan Idris Mambazo, MSW, LICSW-PIP, CGRS's National Provider Identifier is 1609263052, issued on Apr 23, 2015. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Montgomery, AL. The record was last updated on Oct 5, 2026.