Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003203225 |
---|---|
Provider Name | Amy Ashworth |
First Address | Neptune, NJ 07753-2504 |
Second Address | Neptune, NJ 07753-2504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2015 |
Last Update Date | 23/11/2016 |