MEDICARE: LISA ASH

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	104100000X	Social Worker
2	104100000X	Social Worker	106710-01	NY

General Provider Information

NPI Number	:	1619529757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ASH

Provider Business Mailing Address
First Line	:	PO BOX 9136
Second Line	:
City	:	NISKAYUNA
State	:	NY
Zip	:	12309-0136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 LEAR JET LN STE 104N
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2314
Country	:	US
Telephone Number	:	518-560-4277
Fax Number	:

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

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	12/03/2023

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