Healthcare Provider Details

I. General information

NPI: 1194670398
Provider Name (Legal Business Name): ALAN AMBROSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MORTON ST
BOSTON MA
02130-3735
US

IV. Provider business mailing address

170 MORTON ST # 2
BOSTON MA
02130-3735
US

V. Phone/Fax

Practice location:
  • Phone: 617-318-5118
  • Fax: 617-830-8796
Mailing address:
  • Phone: 617-318-5630
  • Fax: 617-983-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: