Provider Demographics
NPI:1346581626
Name:COTO, ASHLEY IVY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:IVY
Last Name:COTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25219 BUNTING CIR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5535
Mailing Address - Country:US
Mailing Address - Phone:813-245-3481
Mailing Address - Fax:
Practice Address - Street 1:8509 BENJAMIN RD
Practice Address - Street 2:SUITE D
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-1224
Practice Address - Country:US
Practice Address - Phone:813-245-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW132041041C0700X
FLISW77731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679096896-67Medicaid