Provider Demographics
NPI:1558178335
Name:AMMAZZALORSO, ABIGAIL GRAYCE
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:GRAYCE
Last Name:AMMAZZALORSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CARTON RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-4304
Mailing Address - Country:US
Mailing Address - Phone:267-401-3216
Mailing Address - Fax:
Practice Address - Street 1:1800 BYBERRY RD STE 1404
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-3526
Practice Address - Country:US
Practice Address - Phone:267-388-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-14
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician