Provider Demographics
NPI:1275647984
Name:AMBROSIO, ANNE T (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:T
Last Name:AMBROSIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:T
Other - Last Name:AMBROSIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5 PERRYRIDGE ROAD
Mailing Address - Street 2:GREENWICH HOSPITAL OPC
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830
Mailing Address - Country:US
Mailing Address - Phone:203-863-3305
Mailing Address - Fax:203-863-4690
Practice Address - Street 1:5 PERRYRIDGE ROAD
Practice Address - Street 2:GREENWICH HOSPITAL OPC
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:203-863-3316
Practice Address - Fax:203-863-4690
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000735104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker