Provider Demographics
NPI:1588411938
Name:PEART, ASHLEY(917) 325-8809
Entity type:Individual
Prefix:
First Name:ASHLEY(917) 325-8809
Middle Name:
Last Name:PEART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24412 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-1604
Mailing Address - Country:US
Mailing Address - Phone:917-325-8809
Mailing Address - Fax:
Practice Address - Street 1:24412 135TH AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1604
Practice Address - Country:US
Practice Address - Phone:917-325-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119619104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker