Provider Demographics
NPI:1245404490
Name:BAIZE, ASHLEY FOGG (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:FOGG
Last Name:BAIZE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GIBBS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1824
Mailing Address - Country:US
Mailing Address - Phone:850-685-0537
Mailing Address - Fax:
Practice Address - Street 1:31 JOHN CLARKE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5641
Practice Address - Country:US
Practice Address - Phone:401-848-4123
Practice Address - Fax:401-848-4156
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9004104100000X
RIISW024401041C0700X
HI37161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker