Provider Demographics
NPI:1184081903
Name:AMBROSE, CHELSEA E (LCSW)
Entity type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:E
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 MEADS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-9509
Mailing Address - Country:US
Mailing Address - Phone:607-962-4100
Mailing Address - Fax:607-962-4300
Practice Address - Street 1:3805 MEADS CREEK RD
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9509
Practice Address - Country:US
Practice Address - Phone:607-962-4100
Practice Address - Fax:607-962-4300
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082524-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker