Provider Demographics
NPI:1659750875
Name:ASHE HAUSER, JEANIE (MATC)
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:
Last Name:ASHE HAUSER
Suffix:
Gender:F
Credentials:MATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14728 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3329
Mailing Address - Country:US
Mailing Address - Phone:718-374-5949
Mailing Address - Fax:646-374-3955
Practice Address - Street 1:14728 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3329
Practice Address - Country:US
Practice Address - Phone:718-374-5949
Practice Address - Fax:646-374-3955
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1209111426101YA0400X
CACCDSA1209111426101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health