Provider Demographics
NPI:1851011134
Name:PATRICK, ASHLEY E (MA, MED, MSED)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:E
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MA, MED, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25021 NORTHERN BLVD LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1353
Mailing Address - Country:US
Mailing Address - Phone:631-827-9189
Mailing Address - Fax:
Practice Address - Street 1:25021 NORTHERN BLVD LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1353
Practice Address - Country:US
Practice Address - Phone:631-827-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty