Provider Demographics
NPI:1053861021
Name:ASTARITA, REBECCA (LCSW, ADS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ASTARITA
Suffix:
Gender:F
Credentials:LCSW, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 LEBANON PIKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1623
Mailing Address - Country:US
Mailing Address - Phone:615-426-7231
Mailing Address - Fax:
Practice Address - Street 1:5116 ROXBOROUGH DR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3208
Practice Address - Country:US
Practice Address - Phone:615-426-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54501041C0700X
TN210171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171100000XOther Service ProvidersAcupuncturist