Provider Demographics
NPI:1457765745
Name:AMBROISE, MATHILDE (MFT)
Entity type:Individual
Prefix:
First Name:MATHILDE
Middle Name:
Last Name:AMBROISE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 N MILITARY TRL
Mailing Address - Street 2:SUITE 223
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6500
Mailing Address - Country:US
Mailing Address - Phone:561-515-5347
Mailing Address - Fax:561-404-4147
Practice Address - Street 1:10800 N MILITARY TRL
Practice Address - Street 2:SUITE 223
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6500
Practice Address - Country:US
Practice Address - Phone:561-515-5347
Practice Address - Fax:561-404-4147
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 1901106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMT 1901OtherDEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE