Provider Demographics
NPI:1245412485
Name:AMBROSE, PRISCILLA C
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:C
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BRANDT TER
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-3403
Mailing Address - Country:US
Mailing Address - Phone:914-194-5113
Mailing Address - Fax:
Practice Address - Street 1:40 BRANDT TER
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-3403
Practice Address - Country:US
Practice Address - Phone:914-319-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY787305103TS0200X
AZ3962516103TS0200X
NY001677-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool