Provider Demographics
NPI:1841241569
Name:LASS, ASHLEY FOGARTY (PSYD, PA)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:FOGARTY
Last Name:LASS
Suffix:
Gender:F
Credentials:PSYD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3616 W ROLAND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2832
Mailing Address - Country:US
Mailing Address - Phone:813-789-3709
Mailing Address - Fax:
Practice Address - Street 1:2425 E HANNA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-1317
Practice Address - Country:US
Practice Address - Phone:813-238-3053
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7188103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical