Provider Demographics
NPI:1245559590
Name:NANCY BASTI PSYCHOLOGICAL CONSULTANTS LLC
Entity Type:Organization
Organization Name:NANCY BASTI PSYCHOLOGICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PROFESSIONAL COUNSEL
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BASTI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-517-9501
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:CT
Mailing Address - Zip Code:06763
Mailing Address - Country:US
Mailing Address - Phone:860-567-2254
Mailing Address - Fax:860-567-2254
Practice Address - Street 1:906 BANTAM RD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750
Practice Address - Country:US
Practice Address - Phone:860-567-2254
Practice Address - Fax:860-567-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001298101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty