Healthcare Provider Details

I. General information

NPI: 1396943163
Provider Name (Legal Business Name): LEE W ASHENDORF PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 BELMONT ST
WORCESTER MA
01604-1019
US

IV. Provider business mailing address

403 BELMONT ST
WORCESTER MA
01604-1019
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-4040
  • Fax:
Mailing address:
  • Phone: 413-584-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8732
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: