Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 255511 | KY |
NPI | 1003232604 |
---|---|
Provider Name | Dr. Joseph D'ambrosio |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202-1218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2014 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100334890 | (05) | KY |
K249310 | MEDICARE (01) | KY |