Provider Demographics
NPI:1649578162
Name:GASTON, PAUL L (LISW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:L
Last Name:GASTON
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ROBERT ST S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1677
Mailing Address - Country:US
Mailing Address - Phone:651-222-6567
Mailing Address - Fax:651-222-6713
Practice Address - Street 1:3925 WOODVIEW CT
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55127-4111
Practice Address - Country:US
Practice Address - Phone:612-799-0498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2967104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker