Healthcare Provider Details

I. General information

NPI: 1518748789
Provider Name (Legal Business Name): ASHLEY ELIZABETH SICILIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 QUEENS BLVD STE 1630
FOREST HILLS NY
11375-7251
US

IV. Provider business mailing address

667 STONELEIGH AVE STE 202
CARMEL NY
10512-2455
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-5908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number013909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: