Provider Demographics
NPI:1720302920
Name:BORN, AMBRA ROBN ROSE (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:AMBRA
Middle Name:ROBN ROSE
Last Name:BORN
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13659 E 104TH AVE
Mailing Address - Street 2:SUITE 500B
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-9402
Mailing Address - Country:US
Mailing Address - Phone:720-347-8836
Mailing Address - Fax:855-244-3591
Practice Address - Street 1:13659 E 104TH AVE
Practice Address - Street 2:SUITE 500B
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-9402
Practice Address - Country:US
Practice Address - Phone:720-347-8836
Practice Address - Fax:855-244-3591
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY-3519103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical