Provider Demographics
NPI:1144811902
Name:ASRELSKY, AMANDA L (LMFT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:L
Last Name:ASRELSKY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 CODDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-6049
Mailing Address - Country:US
Mailing Address - Phone:860-830-6228
Mailing Address - Fax:
Practice Address - Street 1:207 WORTH ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4924
Practice Address - Country:US
Practice Address - Phone:860-830-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001728106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist