Provider Demographics
NPI:1881365823
Name:GLYNN, ASHLEY
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WARREN PL
Mailing Address - Street 2:
Mailing Address - City:NORTH MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-5931
Mailing Address - Country:US
Mailing Address - Phone:908-461-1954
Mailing Address - Fax:
Practice Address - Street 1:50 MILLSTONE RD STE 201
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-1415
Practice Address - Country:US
Practice Address - Phone:609-392-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-21-163938106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRBT-21-163938OtherRBT NUMBER