Provider Demographics
NPI:1356642979
Name:AMBROSE, MARY CATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:AMBROSE
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 1:720 E MAIN ST
Mailing Address - Street 2:STE. 1A
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3058
Mailing Address - Country:US
Mailing Address - Phone:856-722-1755
Mailing Address - Fax:856-727-1715
Practice Address - Street 1:720 E MAIN ST
Practice Address - Street 2:STE. 1A
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3058
Practice Address - Country:US
Practice Address - Phone:856-722-1755
Practice Address - Fax:856-727-1715
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048638001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical