Provider Demographics
NPI:1811326390
Name:ASHBY-WILSON, SADIELYN (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:SADIELYN
Middle Name:
Last Name:ASHBY-WILSON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 W TAFT RD STE 1F
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3808
Mailing Address - Country:US
Mailing Address - Phone:315-458-6111
Mailing Address - Fax:315-458-6121
Practice Address - Street 1:5100 W TAFT RD STE 1F
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3808
Practice Address - Country:US
Practice Address - Phone:315-458-6111
Practice Address - Fax:315-458-6121
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0183071041C0700X
CO14141041C0700X
NY0780661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical