Provider Demographics
NPI:1891037453
Name:BESEMER, ASHLEY EVA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:EVA
Last Name:BESEMER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:EVA
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:ME
Mailing Address - Zip Code:04084-6615
Mailing Address - Country:US
Mailing Address - Phone:413-204-7278
Mailing Address - Fax:
Practice Address - Street 1:22 W COLE RD STE 103
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9431
Practice Address - Country:US
Practice Address - Phone:207-571-9923
Practice Address - Fax:207-517-9927
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEPS1605103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program