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General NPI Number Information
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NPI Number | 1316435407
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Entity Type | Individual
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Provider Name | CAITLIN D AMBO LCPC
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Gender | Female
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 32 NO HIGH STREET
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City | BRIDGTON
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State | ME
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Zip | 04009
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Country | US
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Telephone | 207-647-5329
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Fax | 207-647-5620
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Provider Business Mailing Address
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Address Line | PO BOX 229
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City | OLD ORCHARD BEACH
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State | ME
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Zip | 04064
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Country | US
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Telephone | 207-590-2197
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC6196
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License Number State | ME
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