| Doctor Name: | MS. LARA FASTMAN |
| NPI Number: | 1063598803 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 070867 |
| Business Practice Address: | 351 Manville Rd Suite 101 Pleasantville, NY - 105702152 |
| Business Phone Number: | 9145721723 |
| Business Fax Number: | 9147475675 |
| Mailing Address: | 351 Manville Rd, Suite 101 PLEASANTVILLE |
| State: | NY |
| Postal Code: | 105702152 |
| Phone Number: | 9145721723 |
| Fax Number: | 9147475675 |
| NPI Enumeration Date: | 10/27/2006 |
| NPI Last Update Date: | 03/24/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 070867 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |