Provider Demographics
NPI:1417831066
Name:VASISTA LLC
Entity type:Organization
Organization Name:VASISTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SATYA
Authorized Official - Middle Name:
Authorized Official - Last Name:INDUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:201-233-1177
Mailing Address - Street 1:19 DONLONTON CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08515-9786
Mailing Address - Country:US
Mailing Address - Phone:201-233-1177
Mailing Address - Fax:
Practice Address - Street 1:19 DONLONTON CIR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08515-9786
Practice Address - Country:US
Practice Address - Phone:201-233-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty