Healthcare Provider Details

I. General information

NPI: 1609510452
Provider Name (Legal Business Name): ASHLEY NICOLE CHERRY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 GLEBE AVE
BRONX NY
10461-3109
US

IV. Provider business mailing address

11 W BROADWAY
NYACK NY
10960-2805
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-4400
  • Fax:
Mailing address:
  • Phone: 845-405-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number113652
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: