Provider Demographics
NPI:1538261748
Name:AMBROSIEWICZ, PHILLIP EDWARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:EDWARD
Last Name:AMBROSIEWICZ
Suffix:
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:CARL R DARNALL ARMY MEDICAL CENTER
Mailing Address - Street 2:36000 DARNALL LOOP
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-4752
Mailing Address - Country:US
Mailing Address - Phone:254-288-6474
Mailing Address - Fax:254-288-3281
Practice Address - Street 1:DEPARTMENT OF SOCIAL WORK
Practice Address - Street 2:BUILDING 2255
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-4752
Practice Address - Country:US
Practice Address - Phone:254-288-6474
Practice Address - Fax:254-288-3281
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX304391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical