Provider Demographics
NPI:1083147540
Name:MICHAEL Q. AMBERG, MA, PA
Entity Type:Organization
Organization Name:MICHAEL Q. AMBERG, MA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:561-627-3113
Mailing Address - Street 1:12300 ALTERNATE A1A
Mailing Address - Street 2:SUITE 113
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2205
Mailing Address - Country:US
Mailing Address - Phone:561-627-3113
Mailing Address - Fax:
Practice Address - Street 1:12300 ALTERNATE A1A
Practice Address - Street 2:SUITE 113
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2205
Practice Address - Country:US
Practice Address - Phone:561-627-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT0870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty