Doctor Name: | STEPHEN NASUTA |
NPI Number: | 1104967512 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D. |
License Number: | 048-0000756 |
Business Practice Address: | 28 Park Ave Suite 220 Williston, VT - 054959701 |
Business Phone Number: | 8026517511 |
Business Fax Number: | |
Mailing Address: | Po Box 1157, WILLISTON |
State: | VT |
Postal Code: | 054951157 |
Phone Number: | 8026517511 |
Fax Number: | |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 048-0000756 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |