Provider Demographics
NPI:1487010971
Name:AMBOS, TRACY ELLEN (MSW, LCSW-C, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:ELLEN
Last Name:AMBOS
Suffix:
Gender:F
Credentials:MSW, LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 LANGLEY CT
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20637-2714
Mailing Address - Country:US
Mailing Address - Phone:240-577-5528
Mailing Address - Fax:
Practice Address - Street 1:5100 FETCHER AVENUE
Practice Address - Street 2:
Practice Address - City:JOINT BASE ANDREWS
Practice Address - State:MD
Practice Address - Zip Code:20762
Practice Address - Country:US
Practice Address - Phone:240-612-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3032371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical