Provider Demographics
NPI:1437286218
Name:KASTERNAKIS, AMY J (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:KASTERNAKIS
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 1:1 NAMI LN
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1251
Mailing Address - Country:US
Mailing Address - Phone:609-586-2880
Mailing Address - Fax:
Practice Address - Street 1:1 NAMI LN
Practice Address - Street 2:SUITE 10
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1251
Practice Address - Country:US
Practice Address - Phone:609-586-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001692001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJKA554911Medicare ID - Type Unspecified