Provider Demographics
NPI:1912445792
Name:GUASTELLA, FRANK JOHN I (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:JOHN
Last Name:GUASTELLA
Suffix:I
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 ARTIST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2311
Mailing Address - Country:US
Mailing Address - Phone:631-645-1720
Mailing Address - Fax:
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2813
Practice Address - Country:US
Practice Address - Phone:631-508-5006
Practice Address - Fax:631-369-5433
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090429-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical