Provider Demographics
NPI:1568017382
Name:ASTACIO, STARLIN
Entity Type:Individual
Prefix:
First Name:STARLIN
Middle Name:
Last Name:ASTACIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6424
Mailing Address - Country:US
Mailing Address - Phone:860-489-3391
Mailing Address - Fax:860-489-2604
Practice Address - Street 1:50 LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6424
Practice Address - Country:US
Practice Address - Phone:860-489-3391
Practice Address - Fax:860-489-2604
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CT2535106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1568017382Medicaid