Provider Demographics
NPI:1427890243
Name:AMBRIA PAGE LCSW
Entity type:Organization
Organization Name:AMBRIA PAGE LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER/AUTHORIZED PERSON
Authorized Official - Prefix:
Authorized Official - First Name:AMBRIA
Authorized Official - Middle Name:JACQUELYN
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-315-9248
Mailing Address - Street 1:4 OFFICE PARK DR UNIT 201
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3809
Mailing Address - Country:US
Mailing Address - Phone:904-315-9248
Mailing Address - Fax:386-309-2350
Practice Address - Street 1:4 OFFICE PARK DR UNIT 201
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3809
Practice Address - Country:US
Practice Address - Phone:904-315-9248
Practice Address - Fax:386-309-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)