Individual
AMBERROSE A REALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
12600 CREEKSIDE LN STE 2, FORT MYERS, FL 33919-3353
(239) 343-9235
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9235
(239) 343-4008
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY11322
FL
222Q00000X
Developmental Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116060800
—
FL
Enumeration date
09/26/2012
Last updated
03/23/2023
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