Healthcare Provider Details

I. General information

NPI: 1316297260
Provider Name (Legal Business Name): LAUREN D'AMBROSIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 BROADWAY 2FL 1735
NEW YORK NY
10013
US

IV. Provider business mailing address

447 BROADWAY 2FL 1735
NEW YORK NY
10013
US

V. Phone/Fax

Practice location:
  • Phone: 917-861-5097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05782500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089103
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: