Healthcare Provider Details

I. General information

NPI: 1902426208
Provider Name (Legal Business Name): ELISABETTA AMBROSIA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 N PASEO AQUIMURI
TUCSON AZ
85750-1613
US

IV. Provider business mailing address

PO BOX 35404
TUCSON AZ
85740-5404
US

V. Phone/Fax

Practice location:
  • Phone: 480-382-3840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-005248
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY-005248
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY-005248
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-005248
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: