Provider Demographics
NPI:1477102127
Name:NASTOS, KARISA ELIZABETH (LCSWC)
Entity Type:Individual
Prefix:MISS
First Name:KARISA
Middle Name:ELIZABETH
Last Name:NASTOS
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 LONDONTOWN BLVD STE 130A
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6439
Mailing Address - Country:US
Mailing Address - Phone:410-552-0773
Mailing Address - Fax:443-200-0267
Practice Address - Street 1:1311 LONDONTOWN BLVD STE 130A
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6439
Practice Address - Country:US
Practice Address - Phone:410-552-0773
Practice Address - Fax:443-200-0267
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25315104100000X
1041C0700X
235151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK-252-461-210-871OtherDRIVER'S LICENSE