Provider Demographics
NPI:1104967512
Name:NASUTA, STEPHEN (PSYD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:NASUTA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:NASUTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1157
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-1157
Mailing Address - Country:US
Mailing Address - Phone:802-651-7511
Mailing Address - Fax:
Practice Address - Street 1:28 PARK AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9701
Practice Address - Country:US
Practice Address - Phone:802-651-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000756103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2310Medicaid
VTVN2310Medicare ID - Type Unspecified