Provider Demographics
NPI:1962650341
Name:ZASTROW, CHRISTINE MICHELE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MICHELE
Last Name:ZASTROW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:MICHELE
Other - Last Name:VANDEVEIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:100 SERVAIS WAY
Mailing Address - Street 2:BLDG 90531
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544
Mailing Address - Country:US
Mailing Address - Phone:850-884-3035
Mailing Address - Fax:
Practice Address - Street 1:100 SERVAIS WAY
Practice Address - Street 2:BLDG 90531
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544
Practice Address - Country:US
Practice Address - Phone:850-884-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1624103TC0700X
FLPY9423103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical