Provider Demographics
NPI:1528177037
Name:BROWN, ASHLEY BLAKE (LCSW-R)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BLAKE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:BLAKE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:239 GOLDEN HILL LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6441
Mailing Address - Country:US
Mailing Address - Phone:845-340-4000
Mailing Address - Fax:845-340-4070
Practice Address - Street 1:239 GOLDEN HILL LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6441
Practice Address - Country:US
Practice Address - Phone:845-340-4000
Practice Address - Fax:845-340-4070
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0784801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02855549Medicaid
NY078480OtherNYS EDUCATION DEPARTMENT OFFICE OF THE PROFESSIONS LCSW
NY071963-1OtherLMSW LICENSE