Provider Demographics
NPI:1578220703
Name:LEEDS, ASHLEY RAYNE (LSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAYNE
Last Name:LEEDS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 DURIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2430
Mailing Address - Country:US
Mailing Address - Phone:201-321-8319
Mailing Address - Fax:
Practice Address - Street 1:114 KINDERKAMACK RD
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-2126
Practice Address - Country:US
Practice Address - Phone:201-391-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL066671001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical