Provider Demographics
NPI:1790843480
Name:ASHLEY, ARLENE VIDA (PHD)
Entity Type:Individual
Prefix:
First Name:ARLENE
Middle Name:VIDA
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:PHD
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 670
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-0670
Mailing Address - Country:US
Mailing Address - Phone:845-758-5275
Mailing Address - Fax:
Practice Address - Street 1:68 61 YELLOWSTONE BOULEVARD
Practice Address - Street 2:SUITE NUMBER 106
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3321
Practice Address - Country:US
Practice Address - Phone:718-544-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0058701103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24251OtherEMPIRE BLUE CROSS BLUE SH
NY22952OtherGHI
22952Medicare ID - Type Unspecified