Individual
LERIUS AMBROISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2401 AMBERJACK CT, NAVARRE, FL 32566-2563
(850) 543-9884
Mailing address
2401 AMBERJACK CT, NAVARRE, FL 32566-2563
(850) 543-9884
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100480400
PROVIDER NUMBER
FL
05
—
100480400
—
FL
Enumeration date
10/20/2021
Last updated
10/20/2021
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