Provider Demographics
NPI:1356132948
Name:AMBROSIO, NATHAN (EDD LCSW)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:AMBROSIO
Suffix:
Gender:M
Credentials:EDD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3693 S DULISSE AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-9103
Mailing Address - Country:US
Mailing Address - Phone:949-232-5402
Mailing Address - Fax:
Practice Address - Street 1:1101 S MILLIKEN AVE STE E
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-8112
Practice Address - Country:US
Practice Address - Phone:949-232-5402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1300951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical