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NPI Code Detail

MEDICARE: HOLLY KELLY AMBROSE LCSW

MEDICARE: HOLLY KELLY AMBROSE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker149008654IL

General Provider Information

NPI Number : 1437783222
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY KELLY AMBROSE LCSW
Provider Business Mailing Address
First Line : 11 BRISA LN
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34952-7920
Country : US
Telephone Number : 630-945-0376
Fax Number :
Provider Business Practice Location Address
First Line : 11 BRISA LN
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34952-7920
Country : US
Telephone Number : 331-210-4513
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2020
Last Update Date : 02/18/2026

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Directions to “ HOLLY KELLY AMBROSE LCSW” Practice Location

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