Healthcare Provider Details

I. General information

NPI: 1013283191
Provider Name (Legal Business Name): MARY MARGARET CIAMBELLI PH.D., PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DR
FRISCO CO
80443
US

IV. Provider business mailing address

PO BOX 2820
FRISCO CO
80443-2820
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-3478
  • Fax: 970-668-0632
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0001438-CNS
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: