Provider Demographics
NPI:1598489734
Name:GAVETTE, ASHLEY RUTH (LMSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RUTH
Last Name:GAVETTE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1028
Mailing Address - Country:US
Mailing Address - Phone:585-278-8567
Mailing Address - Fax:
Practice Address - Street 1:63 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1028
Practice Address - Country:US
Practice Address - Phone:585-278-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095176-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker