1063816924 NPI number — ASHLEY K YOUNG MS, BCBA, LABA

Table of content: ASHLEY K YOUNG MS, BCBA, LABA (NPI 1063816924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063816924 NPI number — ASHLEY K YOUNG MS, BCBA, LABA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
ASHLEY
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, BCBA, LABA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABBOTT
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, BCBA, LABA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063816924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 SAN JOSE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02809-4618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-200-1125
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 HILLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02770-4024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-454-1994
Provider Business Practice Location Address Fax Number:
508-273-2353
Provider Enumeration Date:
10/21/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110026265E , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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