Provider Demographics
NPI:1992440036
Name:AMPLO, MARYBETH (MA, LPC, ATR-BC)
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:AMPLO
Suffix:
Gender:F
Credentials:MA, LPC, ATR-BC
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 48392
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28331-8392
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 MANHATTANVILLE RD STE 203
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2118
Practice Address - Country:US
Practice Address - Phone:800-835-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC014318OtherDEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS.