MEDICARE: ASHLEY MARIE DEROSA LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	014269	NY

General Provider Information

NPI Number	:	1548004187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MARIE DEROSA LMHC

Provider Business Mailing Address
First Line	:	231 THORNBERRY LN
Second Line	:
City	:	RENSSELAER
State	:	NY
Zip	:	12144-8453
Country	:	US
Telephone Number	:	518-866-8209
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 BROADWAY STE 310
Second Line	:
City	:	MENANDS
State	:	NY
Zip	:	12204-2726
Country	:	US
Telephone Number	:	518-465-5201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2024
Last Update Date	:	06/19/2024

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