Healthcare Provider Details

I. General information

NPI: 1598787921
Provider Name (Legal Business Name): TANYA ADAIR ASHBAUGH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 CENTRAL AVE STE B
DUNKIRK NY
14048-2137
US

IV. Provider business mailing address

4640 BEMUS ELLERY RD
BEMUS POINT NY
14712-9417
US

V. Phone/Fax

Practice location:
  • Phone: 716-363-6050
  • Fax: 716-363-6851
Mailing address:
  • Phone: 716-366-2122
  • Fax: 716-366-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number066083-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: