Provider Demographics
NPI:1124686779
Name:LAUTURE, ASHLEY (MA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:LAUTURE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 36TH AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1327
Mailing Address - Country:US
Mailing Address - Phone:203-912-8926
Mailing Address - Fax:
Practice Address - Street 1:7000 AUSTIN ST STE 200
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4739
Practice Address - Country:US
Practice Address - Phone:203-912-8926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2023-08-07
Deactivation Date:2023-07-21
Deactivation Code:
Reactivation Date:2023-08-07
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No174400000XOther Service ProvidersSpecialist