Provider Demographics
NPI:1073974226
Name:FASTEN, DEVORAH
Entity Type:Individual
Prefix:
First Name:DEVORAH
Middle Name:
Last Name:FASTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEVORAH
Other - Middle Name:GOLDY
Other - Last Name:KURZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:14131 70TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1936
Mailing Address - Country:US
Mailing Address - Phone:718-413-6016
Mailing Address - Fax:
Practice Address - Street 1:14131 70TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1936
Practice Address - Country:US
Practice Address - Phone:718-413-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst