Healthcare Provider Details

I. General information

NPI: 1912686312
Provider Name (Legal Business Name): ASHLEY M MINER LMSW-P,CRPA, NYCPS-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 10/28/2026
Certification Date: 10/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 THURBER DR
WATERLOO NY
13165-1665
US

IV. Provider business mailing address

31 THURBER DR
WATERLOO NY
13165-1665
US

V. Phone/Fax

Practice location:
  • Phone: 315-539-1980
  • Fax:
Mailing address:
  • Phone: 315-539-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPA-5684
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP146920
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberNYCPS-P-5197
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: