Healthcare Provider Details

I. General information

NPI: 1104423920
Provider Name (Legal Business Name): DEIDRE KASTON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROADHOLLOW RD
MELVILLE NY
11747-4905
US

IV. Provider business mailing address

150 BROADHOLLOW RD
MELVILLE NY
11747-4905
US

V. Phone/Fax

Practice location:
  • Phone: 631-317-2717
  • Fax:
Mailing address:
  • Phone: 631-317-2717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number097680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: