Provider Demographics
NPI:1578994273
Name:NASTA, KERRI LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:LYNN
Last Name:NASTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WOODCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-1913
Mailing Address - Country:US
Mailing Address - Phone:631-332-7160
Mailing Address - Fax:
Practice Address - Street 1:37 WOODCLIFF RD
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-1913
Practice Address - Country:US
Practice Address - Phone:631-332-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096799104100000X
NY089056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional