Provider Demographics
NPI:1659333243
Name:PASTOR, FRED (DSW, LCSW,LLC)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:PASTOR
Suffix:
Gender:M
Credentials:DSW, LCSW,LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1400
Mailing Address - Country:US
Mailing Address - Phone:973-584-4050
Mailing Address - Fax:973-598-9296
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1400
Practice Address - Country:US
Practice Address - Phone:973-584-4050
Practice Address - Fax:973-598-9296
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC050122001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical