Provider Demographics
NPI:1124178538
Name:ASHBURN, JOHN RAYMOND JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RAYMOND
Last Name:ASHBURN
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-0043
Mailing Address - Country:US
Mailing Address - Phone:845-849-1958
Mailing Address - Fax:888-972-5017
Practice Address - Street 1:2345 ROUTE 52 STE F
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-3218
Practice Address - Country:US
Practice Address - Phone:845-629-0034
Practice Address - Fax:888-972-5017
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020349103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03914270Medicaid