Provider Demographics
NPI:1790469427
Name:VARISTE, NATASHA S
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:S
Last Name:VARISTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-3212
Mailing Address - Country:US
Mailing Address - Phone:504-325-9558
Mailing Address - Fax:
Practice Address - Street 1:1435 MADISON ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-3212
Practice Address - Country:US
Practice Address - Phone:150-432-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8682819106S00000X
LA008682819106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician