Provider Demographics
NPI:1093139396
Name:DAMBROSIO, ANGELA (MED)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DAMBROSIO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:NAHANT
Mailing Address - State:MA
Mailing Address - Zip Code:01908-1204
Mailing Address - Country:US
Mailing Address - Phone:508-284-2873
Mailing Address - Fax:
Practice Address - Street 1:66 SPRING RD
Practice Address - Street 2:
Practice Address - City:NAHANT
Practice Address - State:MA
Practice Address - Zip Code:01908-1204
Practice Address - Country:US
Practice Address - Phone:508-284-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health