Provider Demographics
NPI:1932141587
Name:ANASTASIA, GERALD (LSW)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:ANASTASIA
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 W CONNELLY BLVD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1754
Mailing Address - Country:US
Mailing Address - Phone:724-347-2429
Mailing Address - Fax:724-347-3465
Practice Address - Street 1:94 W CONNELLY BLVD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-1754
Practice Address - Country:US
Practice Address - Phone:724-347-2429
Practice Address - Fax:724-347-3465
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1224751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1509690OtherBLUE SHIELD PROVIDER NUMB