Healthcare Provider Details

I. General information

NPI: 1972931384
Provider Name (Legal Business Name): DANA D'AMBROSIO M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANA SMITH BCBA

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WAYNE CT
QUEENSBURY NY
12804-9108
US

IV. Provider business mailing address

17 WAYNE CT
QUEENSBURY NY
12804-9108
US

V. Phone/Fax

Practice location:
  • Phone: 407-361-5131
  • Fax:
Mailing address:
  • Phone: 407-361-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-14568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: