Mary Elisabeth Ambrose, LICSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LICSW128495 Issued in MA

Practice address

16 Center St Ste 517
Northampton, MA 01060-3031

Phone

(413) 624-4324

NPI assigned

Oct 6, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brooklyn Minds Psychiatry, P.C.

  • Psychiatry Physician
  • New York, NY
  • NPI 1992249098
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1619639754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 CHESTNUT HL",
            "city": "GREENFIELD",
            "state": "MA",
            "postal_code": "013013004",
            "telephone_number": "774-293-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 CENTER ST STE 517",
            "city": "NORTHAMPTON",
            "state": "MA",
            "postal_code": "010603031",
            "telephone_number": "413-624-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBROSE",
        "first_name": "MARY",
        "middle_name": "ELISABETH",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-06",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "113290",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MA",
            "license": "LICSW128495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nina Mary Allen, BA
• Marla Ruth Allisan, MSW
• David B Alpern, MD
• Kristin Anne Alrick, PSYD
• Hollis Altman, M.A. CCC-A
• Ambulatory Care Physicians
• Ambulatory Care Physicians at CDH, PC
• Akyaa Amo-Badu
• Jeremy Kent Andersen
• William Anderson

• All providers in Northampton, MA
• Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.