Provider Demographics
NPI:1093753147
Name:ASHLEY FOGARTY LASS, PSY.D.,P.A.
Entity Type:Organization
Organization Name:ASHLEY FOGARTY LASS, PSY.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:FOGARTY
Authorized Official - Last Name:LASS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-789-3709
Mailing Address - Street 1:3616 W ROLAND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2832
Mailing Address - Country:US
Mailing Address - Phone:813-789-3709
Mailing Address - Fax:
Practice Address - Street 1:3616 W ROLAND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2832
Practice Address - Country:US
Practice Address - Phone:813-789-3709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7188103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty