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General NPI Number Information
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NPI Number | 1093216962
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Entity Type | Individual
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Provider Name | JESSICA FAWN AMBROSINI LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 44 UNION AVE
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City | RUTHERFORD
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State | NJ
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Zip | 07070-1275
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Country | US
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Telephone | 201-399-7225
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Fax |
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Provider Business Mailing Address
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Address Line | 210 BOULEVARD FL 2
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City | HASBROUCK HEIGHTS
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State | NJ
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Zip | 07604-1802
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Country | US
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Telephone | 201-286-5910
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SL05792200
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License Number State | NJ
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