Provider Demographics
NPI:1922582055
Name:AMBRICO, TERENCE MICHAEL
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:MICHAEL
Last Name:AMBRICO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 PERSIMMON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1450
Mailing Address - Country:US
Mailing Address - Phone:516-317-6567
Mailing Address - Fax:
Practice Address - Street 1:2220 PERSIMMON RIDGE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1450
Practice Address - Country:US
Practice Address - Phone:516-317-6567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician