Provider Demographics
NPI:1053920678
Name:AMBROSIA PSYCHOLOGY, LLC
Entity type:Organization
Organization Name:AMBROSIA PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBROSIA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:480-382-3840
Mailing Address - Street 1:4605 N PASEO AQUIMURI
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1613
Mailing Address - Country:US
Mailing Address - Phone:480-382-3840
Mailing Address - Fax:
Practice Address - Street 1:4605 N PASEO AQUIMURI
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1613
Practice Address - Country:US
Practice Address - Phone:480-382-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty