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NPI Code Detail

MEDICARE: NICOLE ASHTON PSYD

MEDICARE: NICOLE ASHTON PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPS018482PA

General Provider Information

NPI Number : 1790272888
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ASHTON PSYD
Provider Business Mailing Address
First Line : 249 CLIFFSIDE AVE
Second Line :
City : SHAVERTOWN
State : PA
Zip : 18708-1801
Country : US
Telephone Number : 570-762-1998
Fax Number :
Provider Business Practice Location Address
First Line : 470 WYOMING AVE
Second Line :
City : KINGSTON
State : PA
Zip : 18704-3603
Country : US
Telephone Number : 570-316-6243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2018
Last Update Date : 04/16/2018

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