Provider Demographics
NPI:1760033765
Name:LANDERS, ASHLEY BEACH (LCSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BEACH
Last Name:LANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 DEVONSHIRE ST STE 901
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-1485
Mailing Address - Country:US
Mailing Address - Phone:617-259-1895
Mailing Address - Fax:617-259-1899
Practice Address - Street 1:185 DEVONSHIRE ST STE 901
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1485
Practice Address - Country:US
Practice Address - Phone:617-259-1895
Practice Address - Fax:617-259-1899
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225020104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker