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NPI Code Detail

MEDICARE: KIMBERLY ANN DEAMBROSIO MAED

MEDICARE: KIMBERLY ANN DEAMBROSIO MAED
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLH60714844WA

General Provider Information

NPI Number : 1912158270
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ANN DEAMBROSIO MAED
Provider Business Mailing Address
First Line : 15020 57TH PL W
Second Line :
City : EDMONDS
State : WA
Zip : 98026-4210
Country : US
Telephone Number : 206-412-4023
Fax Number :
Provider Business Practice Location Address
First Line : 21907 64TH AVE W STE 200
Second Line :
City : MOUNTLAKE TERRACE
State : WA
Zip : 98043-6200
Country : US
Telephone Number : 206-412-4023
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2008
Last Update Date : 04/08/2020

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Directions to “ KIMBERLY ANN DEAMBROSIO MAED” Practice Location

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