Provider Demographics
NPI:1932397791
Name:ABASTA, EDWARD RAYMOND (CAADAC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:RAYMOND
Last Name:ABASTA
Suffix:
Gender:M
Credentials:CAADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3660
Mailing Address - Country:US
Mailing Address - Phone:626-792-8797
Mailing Address - Fax:626-792-8798
Practice Address - Street 1:2331 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3660
Practice Address - Country:US
Practice Address - Phone:626-792-8797
Practice Address - Fax:626-792-8798
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)