Provider Demographics
NPI:1477535128
Name:VASEY, ANN LESLIE (MED)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:LESLIE
Last Name:VASEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2164
Mailing Address - Country:US
Mailing Address - Phone:978-562-3823
Mailing Address - Fax:
Practice Address - Street 1:21 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2164
Practice Address - Country:US
Practice Address - Phone:978-562-3823
Practice Address - Fax:508-881-2527
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC 68101YM0800X
MALMFT 123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1039816OtherCIGNA
LF0028OtherBCBS
1084330OtherFALLON
9082099OtherAETNA
MALM0126OtherBC/BS