Provider Demographics
NPI:1437791902
Name:HENNESSEY, ASHLEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 STAMPERS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1604
Mailing Address - Country:US
Mailing Address - Phone:610-737-7620
Mailing Address - Fax:
Practice Address - Street 1:234 STAMPERS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1604
Practice Address - Country:US
Practice Address - Phone:610-737-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006288101YP2500X
PAPS018721103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional