Healthcare Provider Details

I. General information

NPI: 1902455173
Provider Name (Legal Business Name): ASHLEY GEANEY ERVIN LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W 36TH ST APT 21H
NEW YORK NY
10018-0679
US

IV. Provider business mailing address

515 W 36TH ST APT 21H
NEW YORK NY
10018-0679
US

V. Phone/Fax

Practice location:
  • Phone: 212-696-1550
  • Fax: 917-464-3662
Mailing address:
  • Phone: 314-495-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number002677
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: