Provider Demographics
NPI:1275990988
Name:DEBALFO-AMBROSIO, KARYN (LCSW)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:DEBALFO-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 1:209 COOPER AVE
Mailing Address - Street 2:SUITE 5D
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1883
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 COOPER AVE
Practice Address - Street 2:SUITE 5D
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1883
Practice Address - Country:US
Practice Address - Phone:973-216-5446
Practice Address - Fax:973-244-0716
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054163001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical