Provider Demographics
NPI:1083190102
Name:MARYYANEK, ASHLEY MARIE (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:MARIE
Last Name:MARYYANEK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 LAKE AVE APT 820
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1163
Mailing Address - Country:US
Mailing Address - Phone:774-670-8485
Mailing Address - Fax:
Practice Address - Street 1:65 LAKE AVE APT 820
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1163
Practice Address - Country:US
Practice Address - Phone:774-670-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1208001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical