Provider Demographics
NPI:1861822553
Name:O'HEARN, ASHLEY ESTELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ESTELLE
Last Name:O'HEARN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4257
Mailing Address - Country:US
Mailing Address - Phone:781-544-6874
Mailing Address - Fax:781-205-1536
Practice Address - Street 1:79 SUMMER ST
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4257
Practice Address - Country:US
Practice Address - Phone:781-544-6874
Practice Address - Fax:781-205-1536
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical