Provider Demographics
NPI:1215278528
Name:RASHBA, AMY G (MSW,LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:G
Last Name:RASHBA
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 WHALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-1144
Mailing Address - Country:US
Mailing Address - Phone:203-389-5599
Mailing Address - Fax:203-389-5904
Practice Address - Street 1:1440 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1144
Practice Address - Country:US
Practice Address - Phone:203-389-5599
Practice Address - Fax:203-389-5904
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002200101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040572Medicaid
CT004040572Medicaid