Provider Demographics
NPI:1245999028
Name:AMBROSE, LYUDMILA VITALIA (TAXONOMY MSW)
Entity type:Individual
Prefix:MRS
First Name:LYUDMILA
Middle Name:VITALIA
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:TAXONOMY MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 EMERALD CHASE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5882
Mailing Address - Country:US
Mailing Address - Phone:321-446-1623
Mailing Address - Fax:
Practice Address - Street 1:10850 EMERALD CHASE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5882
Practice Address - Country:US
Practice Address - Phone:321-446-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
FLSW238971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health