Provider Demographics
NPI:1447599626
Name:ANDERSON, ASHLEY (LMSW, CASAC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 COLUMBUS AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5129
Mailing Address - Country:US
Mailing Address - Phone:347-903-0871
Mailing Address - Fax:917-591-7429
Practice Address - Street 1:451 W END AVE
Practice Address - Street 2:SUITE 2H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5347
Practice Address - Country:US
Practice Address - Phone:347-903-0871
Practice Address - Fax:917-591-7429
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080296101Y00000X, 101YA0400X, 101YM0800X, 104100000X, 1041C0700X, 171M00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional