Provider Demographics
NPI:1548403611
Name:GASTOLOMENDO, RITA KAREN (LMSW)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:KAREN
Last Name:GASTOLOMENDO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 81ST ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1322
Mailing Address - Country:US
Mailing Address - Phone:917-604-0308
Mailing Address - Fax:
Practice Address - Street 1:3325 81ST ST APT 1B
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-1322
Practice Address - Country:US
Practice Address - Phone:917-604-0308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-19
Last Update Date:2009-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076252104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker