Provider Demographics
NPI:1962101972
Name:WEIDNER, ASHLEY (LCSW)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WEIDNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 TULIP ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5080
Mailing Address - Country:US
Mailing Address - Phone:607-242-6289
Mailing Address - Fax:
Practice Address - Street 1:902 TULIP ST APT 3
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5080
Practice Address - Country:US
Practice Address - Phone:607-242-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092857-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical