Provider Demographics
NPI:1609020171
Name:AMBROZ, JULIANN R (MED, LCMHC)
Entity Type:Individual
Prefix:
First Name:JULIANN
Middle Name:R
Last Name:AMBROZ
Suffix:
Gender:F
Credentials:MED, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 DANVILLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:VT
Mailing Address - Zip Code:05647-9628
Mailing Address - Country:US
Mailing Address - Phone:802-380-2282
Mailing Address - Fax:
Practice Address - Street 1:39 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843-0147
Practice Address - Country:US
Practice Address - Phone:802-472-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680057568101YM0800X
VT101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool