Provider Demographics
NPI:1184799801
Name:ASHBY, TEARLE DEVIN (MSW)
Entity type:Individual
Prefix:MR
First Name:TEARLE
Middle Name:DEVIN
Last Name:ASHBY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4B BROOKSIDE MDWS
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-9012
Mailing Address - Country:US
Mailing Address - Phone:518-605-5128
Mailing Address - Fax:
Practice Address - Street 1:1758 UNION ST
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-6314
Practice Address - Country:US
Practice Address - Phone:518-982-1274
Practice Address - Fax:518-982-1277
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0449271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical