Provider Demographics
NPI:1093380321
Name:AMBUSKE, CARLY (LSW)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:AMBUSKE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6753 COORS ST
Mailing Address - Street 2:PO BOX 804
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-1364
Mailing Address - Country:US
Mailing Address - Phone:814-366-0402
Mailing Address - Fax:
Practice Address - Street 1:4430 ARAPAHOE AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1196
Practice Address - Country:US
Practice Address - Phone:720-310-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131972104100000X
CO0009925257104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker