Provider Demographics
NPI:1699985408
Name:AMBROSIA, LINDA (MA, LMFT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:AMBROSIA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91027
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-1027
Mailing Address - Country:US
Mailing Address - Phone:808-443-6390
Mailing Address - Fax:
Practice Address - Street 1:3931 GALACTICA DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-1439
Practice Address - Country:US
Practice Address - Phone:808-443-6390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37549106H00000X
HI119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist