Provider Demographics
NPI:1386761179
Name:ASH, MICHAEL DEAN SR (LCSWR)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DEAN
Last Name:ASH
Suffix:SR
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-3106
Mailing Address - Country:US
Mailing Address - Phone:646-261-3215
Mailing Address - Fax:
Practice Address - Street 1:56 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-3106
Practice Address - Country:US
Practice Address - Phone:646-261-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057950101YM0800X
NYR0579501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health