Provider Demographics
NPI:1548928401
Name:AMBROSE, ELIZABETH COURTNEY (MT-BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:COURTNEY
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 EVE DR APT A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-1057
Mailing Address - Country:US
Mailing Address - Phone:412-296-1873
Mailing Address - Fax:
Practice Address - Street 1:205 CONSTITUTION CT
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9583
Practice Address - Country:US
Practice Address - Phone:724-825-6102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16925225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist