Provider Demographics
NPI:1164936050
Name:AMBROZEWICZ, KRISTOPHER DANIEL (LADC-I)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:DANIEL
Last Name:AMBROZEWICZ
Suffix:
Gender:M
Credentials:LADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ESSEX ST # 2
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-2208
Mailing Address - Country:US
Mailing Address - Phone:978-350-5003
Mailing Address - Fax:
Practice Address - Street 1:250 SPRING HILL RD
Practice Address - Street 2:
Practice Address - City:ASHBY
Practice Address - State:MA
Practice Address - Zip Code:01431-2213
Practice Address - Country:US
Practice Address - Phone:978-913-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23268101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health