Provider Demographics
NPI:1821112731
Name:KASTBERG, SIGNE M (PHD, NCC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:SIGNE
Middle Name:M
Last Name:KASTBERG
Suffix:
Gender:F
Credentials:PHD, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3127
Mailing Address - Country:US
Mailing Address - Phone:585-944-4812
Mailing Address - Fax:
Practice Address - Street 1:3690 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3537
Practice Address - Country:US
Practice Address - Phone:585-385-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health