Provider Demographics
NPI:1639752611
Name:SALLEY, ASHLEY ELICIA (BCBA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELICIA
Last Name:SALLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 CARLTON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6466
Mailing Address - Country:US
Mailing Address - Phone:917-647-3475
Mailing Address - Fax:
Practice Address - Street 1:1449 37TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4380
Practice Address - Country:US
Practice Address - Phone:718-215-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP109102103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst