Provider Demographics
NPI:1487901526
Name:ASBURY, EARLINE MONIQUE (MED, CRC, CASAC,)
Entity type:Individual
Prefix:MRS
First Name:EARLINE
Middle Name:MONIQUE
Last Name:ASBURY
Suffix:
Gender:F
Credentials:MED, CRC, CASAC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10425 142ND ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5027
Mailing Address - Country:US
Mailing Address - Phone:646-401-9700
Mailing Address - Fax:646-401-9701
Practice Address - Street 1:1366 INWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3203
Practice Address - Country:US
Practice Address - Phone:646-401-9700
Practice Address - Fax:646-401-9701
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCRC-0053824101Y00000X
NYCASAC-19821101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)