Provider Demographics
NPI:1346890951
Name:TESTA, ASHLEY MARIE (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:MARIE
Last Name:TESTA
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 1:3 YORK SHORES DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-5369
Mailing Address - Country:US
Mailing Address - Phone:617-548-0591
Mailing Address - Fax:
Practice Address - Street 1:3 YORK SHORES DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-5369
Practice Address - Country:US
Practice Address - Phone:617-548-0591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1141831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA114183OtherCOMMONWEALTH OF MASSACHUSETTS