Provider Demographics
NPI:1548812043
Name:PUTTASWAMY, ASH (PSYD)
Entity type:Individual
Prefix:DR
First Name:ASH
Middle Name:
Last Name:PUTTASWAMY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1418
Mailing Address - Country:US
Mailing Address - Phone:845-987-4974
Mailing Address - Fax:
Practice Address - Street 1:52 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND FALLS
Practice Address - State:NY
Practice Address - Zip Code:10928-1303
Practice Address - Country:US
Practice Address - Phone:845-446-4761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2531220103TS0200X
NY023283103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool