Provider Demographics
NPI:1326837881
Name:AMBROSE, LILLIAN MARIE
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MARIE
Last Name:AMBROSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 YARDLEY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2397
Mailing Address - Country:US
Mailing Address - Phone:707-870-9488
Mailing Address - Fax:
Practice Address - Street 1:1636 YARDLEY ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2397
Practice Address - Country:US
Practice Address - Phone:707-870-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician