Provider Demographics
NPI:1407493158
Name:MANN, ASHLEY DANA (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DANA
Last Name:MANN
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 1:22 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1034
Mailing Address - Country:US
Mailing Address - Phone:518-944-4622
Mailing Address - Fax:
Practice Address - Street 1:5 HDSN VLY PROF PLZ
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3150
Practice Address - Country:US
Practice Address - Phone:845-595-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088786-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical