Provider Demographics
NPI:1235151762
Name:ST. JUSTE, CHARLOTTE F (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:F
Last Name:ST. JUSTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CONTINENTAL PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2221
Mailing Address - Country:US
Mailing Address - Phone:646-306-7213
Mailing Address - Fax:
Practice Address - Street 1:54 CONTINENTAL PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2221
Practice Address - Country:US
Practice Address - Phone:646-306-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0844921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA086201MOtherSENTARA
VA178274OtherANTHEM BLUE CROSS BLUE SHIELD
VA353677OtherMHN
VA010162033Medicaid
VA010162033Medicaid
VA178274OtherANTHEM BLUE CROSS BLUE SHIELD
VA546194Medicare UPIN
VA353677Medicare UPIN