Provider Demographics
NPI:1790393098
Name:ASHLEY, LIZA
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:ASHLEY
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:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01038-0106
Mailing Address - Country:US
Mailing Address - Phone:413-247-6364
Mailing Address - Fax:
Practice Address - Street 1:62 MAIN ST BLDG 2-3U
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:MA
Practice Address - Zip Code:01038-7920
Practice Address - Country:US
Practice Address - Phone:413-247-6364
Practice Address - Fax:413-247-6163
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst