Provider Demographics
NPI:1114571049
Name:AMBROSIO, BRYCEE KAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRYCEE
Middle Name:KAY
Last Name:AMBROSIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13810 EMERSON ST APT 113
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6133
Mailing Address - Country:US
Mailing Address - Phone:727-386-2816
Mailing Address - Fax:
Practice Address - Street 1:390 PONDELLA RD STE 9
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4340
Practice Address - Country:US
Practice Address - Phone:239-652-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW154421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty