Ambria Jacquelyn Page, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

SW12139 Issued in FL

Practice address

1 Hargrove Grade Ste 1E
Palm Coast, FL 32137-5116

Phone

(904) 315-9248

Fax

(386) 309-2350

NPI assigned

Feb 10, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 1, 2025 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Ambria Page LCSW

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Palm Coast, FL
  • NPI 1427890243
  NPD Authorized official
• Iest. Augustine Youth Services

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • St Augustine, FL
  • NPI 1023417045
  NPD (past)
• St Augustine Youth Services

  • Mental Illness Community Based Residential Treatment Facility
  • St. Augustine, FL
  • NPI 1699816900
  NPD (past)

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

{
    "created_epoch": "1328832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1821361619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HARGROVE GRADE STE 1E",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321375116",
            "telephone_number": "904-315-9248",
            "fax_number": "386-309-2350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HARGROVE GRADE STE 1E",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321375116",
            "telephone_number": "904-315-9248",
            "fax_number": "386-309-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAGE",
        "first_name": "AMBRIA",
        "middle_name": "JACQUELYN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-10",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "SW12139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ronaldo Pacifico
• Rosa Dilia Pacumio
• Brenda Sue Paine, RN
• Palm Coast Acupuncture LLC
• Palm Coast Alf Management LLC
• Palm Coast Cardiovascular Institute PL
• Palm Coast Counseling, LLC

• All providers in Palm Coast, FL
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.