Provider Demographics
NPI:1033718598
Name:BRILL, ASHLEY ROSE
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:ROSE
Last Name:BRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ANTHONY DR APT D209
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5578
Mailing Address - Country:US
Mailing Address - Phone:631-905-7290
Mailing Address - Fax:
Practice Address - Street 1:25 ANTHONY DR APT D209
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5578
Practice Address - Country:US
Practice Address - Phone:631-905-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-20-42615103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst