Provider Demographics
NPI:1174692594
Name:AMBERG, MICHAEL Q (MA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:Q
Last Name:AMBERG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 ALT A1A STE 113
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2206
Mailing Address - Country:US
Mailing Address - Phone:561-627-3113
Mailing Address - Fax:
Practice Address - Street 1:12300 ALT A1A STE 113
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2206
Practice Address - Country:US
Practice Address - Phone:561-627-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT # 0870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist