Provider Demographics
NPI:1366054603
Name:AMBROSIO, KRISTEN ANN (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:AMBROSIO
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 1:44 WASHBURN RD
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1642
Mailing Address - Country:US
Mailing Address - Phone:201-803-0208
Mailing Address - Fax:
Practice Address - Street 1:15 FARVIEW TER STE 1
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2762
Practice Address - Country:US
Practice Address - Phone:515-579-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051664001041C0700X
NJ44SCO51664001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty