Provider Demographics
NPI:1720527526
Name:FAST, MARIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:FAST
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1120
Mailing Address - Country:US
Mailing Address - Phone:518-396-0009
Mailing Address - Fax:
Practice Address - Street 1:31 HERRICK AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1120
Practice Address - Country:US
Practice Address - Phone:518-396-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012470103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist