Healthcare Provider Details

I. General information

NPI: 1619467214
Provider Name (Legal Business Name): ASHLEY MARIE ARBUCKLE M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WAREN STREET BUILDING 9
BRIGHTON MA
02135
US

IV. Provider business mailing address

351 S HUNTINGTON AVE APT 2
JAMAICA PLAIN MA
02130-4887
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-0964
  • Fax:
Mailing address:
  • Phone: 484-252-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: