Provider Demographics
NPI:1467839308
Name:BROSZKIEWICZ, NASTASSIA DOROTA (LPA, HSP-PA, LCASA)
Entity Type:Individual
Prefix:
First Name:NASTASSIA
Middle Name:DOROTA
Last Name:BROSZKIEWICZ
Suffix:
Gender:F
Credentials:LPA, HSP-PA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8699
Mailing Address - Country:US
Mailing Address - Phone:828-505-3086
Mailing Address - Fax:
Practice Address - Street 1:6 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8699
Practice Address - Country:US
Practice Address - Phone:828-505-3086
Practice Address - Fax:828-274-6377
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4773103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist