Provider Demographics
NPI:1376892356
Name:AMBRO, JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:AMBRO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:NICKNISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 17688
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80402-6028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16154 ROCK CRYSTAL DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3305
Practice Address - Country:US
Practice Address - Phone:303-946-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9930511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical