Provider Demographics
NPI:1831568252
Name:NICASTRO, TINA GRINOLD (LAC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:GRINOLD
Last Name:NICASTRO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 OLDE STAGE RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3249
Mailing Address - Country:US
Mailing Address - Phone:860-268-2092
Mailing Address - Fax:
Practice Address - Street 1:192 PARK RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2013
Practice Address - Country:US
Practice Address - Phone:860-284-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000644171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist