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General NPI Number Information
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NPI Number | 1598427585
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Entity Type | Individual
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Provider Name | MERIDITH LARA AMBROSE PHD
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Gender | Female
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Dates
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Enumeration Date | 10/07/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 295 CENTRAL PARK W OFC 6
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City | NEW YORK
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State | NY
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Zip | 10024-3021
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Country | US
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Telephone | 973-600-8866
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Fax |
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Provider Business Mailing Address
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Address Line | 28 W 3RD ST APT 1430
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1787
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Country | US
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Telephone | 973-600-8866
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 023769
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License Number State | NY
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