Provider Demographics
NPI:1760749964
Name:AMBROSE, JULIE KAY (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:KAY
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 SW 152ND ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1825
Mailing Address - Country:US
Mailing Address - Phone:206-498-0425
Mailing Address - Fax:
Practice Address - Street 1:929 SW 152ND ST UNIT D
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1825
Practice Address - Country:US
Practice Address - Phone:206-498-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000075131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical