Provider Demographics
NPI:1942851944
Name:ANASTASIO, CARLY ANNE (LSW)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:ANNE
Last Name:ANASTASIO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 COLONIAL DR APT K
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-3622
Mailing Address - Country:US
Mailing Address - Phone:610-858-1198
Mailing Address - Fax:
Practice Address - Street 1:645 PENN ST FL 2
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3543
Practice Address - Country:US
Practice Address - Phone:610-373-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136558104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker