Provider Demographics
NPI:1376872770
Name:AMBROSIO, JOAN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:AMBROSIO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3130
Mailing Address - Country:US
Mailing Address - Phone:516-633-3544
Mailing Address - Fax:
Practice Address - Street 1:32 CARLTON AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3130
Practice Address - Country:US
Practice Address - Phone:516-633-3544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026838174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY026838OtherNEW YORK STATE IDENFICATION LICENSED CLINICAL SOCIAL WORKER