MEDICARE: AMBROSIA PSYCHOLOGY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	103TC1900X	Counseling Psychologist
3	103TC2200X	Clinical Child & Adolescent Psychologist
4	101YM0800X	Mental Health Counselor
5	103T00000X	Psychologist
6	103TA0700X	Adult Development & Aging Psychologist
7	103TB0200X	Cognitive & Behavioral Psychologist
8	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1619846862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBROSIA PSYCHOLOGY INC

Provider Business Mailing Address
First Line	:	11740 SAN VICENTE BLVD STE 109-316
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6610
Country	:	US
Telephone Number	:	323-732-8699
Fax Number	:

Provider Business Practice Location Address
First Line	:	2444 WILSHIRE BLVD STE 202
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5810
Country	:	US
Telephone Number	:	323-732-8699
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELISABETTA AMBROSIA
Credential	:
Telephone Number	:	818-732-8699

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	11/04/2025

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