Provider Demographics
NPI:1932480514
Name:D'AMBROSIO, ADRIENNE LISA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:LISA
Last Name:D'AMBROSIO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BAYVILLE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1842
Mailing Address - Country:US
Mailing Address - Phone:516-647-5333
Mailing Address - Fax:
Practice Address - Street 1:23 BAYVILLE PARK BLVD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11709-1842
Practice Address - Country:US
Practice Address - Phone:516-647-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018390235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist