Provider Demographics
NPI:1558052050
Name:PASTENA, JOSEPHINE (RMHCI)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:PASTENA
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CORAL REEF WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-1138
Mailing Address - Country:US
Mailing Address - Phone:973-714-0391
Mailing Address - Fax:
Practice Address - Street 1:1450 N US HIGHWAY 1 STE 500
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6623
Practice Address - Country:US
Practice Address - Phone:386-449-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH23959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health