Provider Demographics
NPI:1750832796
Name:BATES, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GARDENVILLE PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1399
Mailing Address - Country:US
Mailing Address - Phone:716-431-4090
Mailing Address - Fax:716-242-0244
Practice Address - Street 1:40 GARDENVILLE PKWY STE 208
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1399
Practice Address - Country:US
Practice Address - Phone:716-431-4090
Practice Address - Fax:716-242-0244
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0909841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical