Provider Demographics
NPI:1225916562
Name:AMBROISE, NEISSA
Entity type:Individual
Prefix:
First Name:NEISSA
Middle Name:
Last Name:AMBROISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 CUMMINS HWY
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2039
Mailing Address - Country:US
Mailing Address - Phone:857-427-9432
Mailing Address - Fax:
Practice Address - Street 1:1234 HYDE PARK AVE STE 202
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2819
Practice Address - Country:US
Practice Address - Phone:888-763-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical