Healthcare Provider Details

I. General information

NPI: 1124686779
Provider Name (Legal Business Name): ASHLEY LAUTURE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date: 07/21/2023
Reactivation Date: 08/07/2023

III. Provider practice location address

7000 AUSTIN ST STE 200
FOREST HILLS NY
11375-4739
US

IV. Provider business mailing address

3407 36TH AVE APT 1E
ASTORIA NY
11106-1327
US

V. Phone/Fax

Practice location:
  • Phone: 203-912-8926
  • Fax:
Mailing address:
  • Phone: 203-912-8926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: