Provider Demographics
NPI:1710218516
Name:BAROS, AMBROSE (LCSW, LADAC)
Entity type:Individual
Prefix:
First Name:AMBROSE
Middle Name:
Last Name:BAROS
Suffix:
Gender:M
Credentials:LCSW, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3936 MOUNTAIN TRAIL LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-7001
Mailing Address - Country:US
Mailing Address - Phone:505-927-1024
Mailing Address - Fax:
Practice Address - Street 1:4210 MEADOWLARK LN SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1021
Practice Address - Country:US
Practice Address - Phone:505-927-1024
Practice Address - Fax:505-988-7328
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCAD0189011101YA0400X
171M00000X
NMC-103271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator